Kumalasari Regina Indah, Kosasih Cecep Eli, Priambodo Ayu Prawesti
Master Study Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia.
Vasc Health Risk Manag. 2025 Jan 8;21:1-15. doi: 10.2147/VHRM.S479352. eCollection 2025.
Delayed extubation (DE) after cardiac surgery is associated with high morbidity, mortality, increased length of stay in the intensive care unit, and hospital costs. Various studies have identified factors that influence the occurrence of DE in patients after cardiac surgery, but no review has systematically synthesized the results.
This review aimed to identify the influencing factors and the leading causes of DE in patients after cardiac surgery.
This scoping review uses the framework developed by Arksey and O'Malley (2005). Literature was searched through four databases: PubMed, Scopus, Science Direct, and CINAHL, and two search engines, Sage and Google Scholar, accessed on October 20, 2024. The articles analyzed met the inclusion criteria, such as full-text articles in English, published from 2014-2024, with case-control, cross-sectional, longitudinal, and cohort study designs and had good quality as assessed using the Joanna Briggs Institute critical appraisal checklist. Data was synthesized using thematic analysis.
Eight articles with a total of 13801 participants were included in this review. The prevalence of DE after cardiac surgery ranged from 13.6% to 91.9%. The factors affecting DE were categorized into preoperative, intraoperative and postoperative. The factors most commonly reported to influence ED include preoperative factors (age ≥ 60 and EF < 50%), intraoperative factors (duration of surgery ≥7 hours, use of IABP and sedatives), and postoperative factors (BNP≥806 pg/mL). The leading causes of DE after cardiac surgery are hemodynamic instability requiring increased inotropes (33.51%), reduced level of consciousness or drowsiness (31.91%), and postoperative bleeding (20.74%).
The process of extubation is a crucial phase in postoperative care. By comprehending the elements that impact DE, healthcare providers can effectively allocate medical resources to enhance the success of weaning, extubation, and recovery following cardiac surgery. Consequently, further research focusing on DE is essential, particularly in patients who have undergone cardiac surgery.
心脏手术后延迟拔管（DE）与高发病率、死亡率、重症监护病房住院时间延长及医院费用增加相关。多项研究已确定影响心脏手术后患者发生DE的因素，但尚无综述对结果进行系统综合。
本综述旨在确定心脏手术后患者DE的影响因素及主要原因。
本范围综述采用Arksey和O'Malley（2005年）开发的框架。通过四个数据库（PubMed、Scopus、Science Direct和CINAHL）以及两个搜索引擎（Sage和Google Scholar）进行文献检索，检索时间为2024年10月20日。所分析的文章符合纳入标准，如2014 - 2024年发表的英文全文文章，采用病例对照、横断面、纵向和队列研究设计，且使用乔安娜·布里格斯研究所批判性评价清单评估质量良好。数据采用主题分析进行综合。
本综述纳入了8篇文章，共13801名参与者。心脏手术后DE的发生率在13.6%至91.9%之间。影响DE的因素分为术前、术中和术后。最常报告影响DE的因素包括术前因素（年龄≥60岁和射血分数<50%）、术中因素（手术时间≥7小时、使用主动脉内球囊反搏和镇静剂）和术后因素（B型钠尿肽≥806 pg/mL）。心脏手术后DE的主要原因是需要增加血管活性药物支持的血流动力学不稳定（33.51%）、意识水平降低或嗜睡（31.91%）以及术后出血（20.74%）。
拔管过程是术后护理的关键阶段。通过了解影响DE的因素，医疗保健提供者可以有效分配医疗资源，以提高心脏手术后脱机、拔管和恢复的成功率。因此，针对DE的进一步研究至关重要，尤其是在接受心脏手术的患者中。
