Paarmann Hauke, Hanke Thorsten, Heringlake Matthias, Heinze Hermann, Brandt Sebastian, Brauer Kirk, Karsten Jan, Schön Julika
Department of Anesthesiology, University of Lübeck, Lübeck, Germany.
Interact Cardiovasc Thorac Surg. 2012 Sep;15(3):400-5. doi: 10.1093/icvts/ivs228. Epub 2012 Jun 12.
Fast-track cardiac anaesthesia programs aiming at early tracheal extubation have not only been linked to a decrease in intensive care unit and hospital length of stay but also to a decrease in morbidity and mortality as well as a containment of rising medical costs. General recommendations for the inclusion criteria concerning fast-track programs are not available.
The present study determined the factors influencing the time to extubation in patients undergoing a newly implemented fast-track protocol. Seventy-nine patients were retrospectively studied. Successful fast track was defined as time to extubation within 75 min after admission to ICU.
Sixty patients fulfilled the successful fast-track criteria with a mean time to extubation of 43.9 min (range 15-75 min). Nineteen patients needed more than 75 min to be weaned from the respirator with a mean time to extubation of 135 min (range 90-320 min). Analysis of pre- and intraoperative factors revealed that these groups differed only with respect to preoperative cerebral oxygen saturation levels: 67.7 ± 5.2 versus 60.8 ± 7.4%.
Cerebral oxygen saturation assessment prior to cardiac surgery is significantly related to time to extubation and may thus be used to stratify candidates in fast-track programs.
旨在早期气管拔管的快速心脏麻醉方案不仅与重症监护病房和住院时间的缩短有关，还与发病率和死亡率的降低以及控制不断上升的医疗成本有关。目前尚无关于快速通道方案纳入标准的通用建议。
本研究确定了影响新实施快速通道方案患者拔管时间的因素。对79例患者进行了回顾性研究。成功的快速通道定义为入住重症监护病房后75分钟内拔管。
60例患者符合成功的快速通道标准，平均拔管时间为43.9分钟（范围15 - 75分钟）。19例患者需要超过75分钟才能脱离呼吸机，平均拔管时间为135分钟（范围90 - 320分钟）。术前和术中因素分析显示，这些组仅在术前脑氧饱和度水平方面存在差异：分别为67.7±5.2%和60.8±7.4%。
心脏手术前的脑氧饱和度评估与拔管时间显著相关，因此可用于快速通道方案中对患者进行分层。
