Prakash O, Jonson B, Meij S, Bos E, Hugenholtz P G, Nauta J, Hekman W
Anesth Analg. 1977 Sep-Oct;56(5):703-8. doi: 10.1213/00000539-197709000-00019.
Of 142 adult patients undergoing open-heart surgery, 123 were extubated either in the operating room or within 3 hours after admission to the recovery room, to avoid the discomfort and risks of prolonged mechanical ventilation. The remaining 19 patients, who had impaired cardiac function, were mechanically ventilated for 1 to 7 days postoperatively. The most important criteria for cardiopulmonary malfunction indicating the need for continued mechnical ventilation were a low mixed venous O2 saturation (SVO2) of less than 60% and a high left atrial pressure (greater than 20 torr). Of the 123 patients, 118, had an uneventful postoperative recovery and 5 needed reintubation, 2 because of low SVO2 and 3 because of complications unrelated to respiratory management. Most adult patients can spontaneously breathe adequately immediately after or within 3 hours of completed open-heart surgery, but a thorough physiologic and clinical evaluation should precede extubation, to identify those who need prolonged mechanical ventilation in the postoperative phase. Criteria for selection of patients for early extubation are presented.
在142例接受心脏直视手术的成年患者中，123例在手术室或进入恢复室后3小时内拔除气管插管，以避免长时间机械通气带来的不适和风险。其余19例心功能受损的患者术后接受了1至7天的机械通气。提示需要持续机械通气的心肺功能不全的最重要标准是混合静脉血氧饱和度（SVO2）低于60%和左心房压力升高（大于20托）。在123例患者中，118例术后恢复顺利，5例需要再次插管，2例是因为SVO2低，3例是因为与呼吸管理无关的并发症。大多数成年患者在心脏直视手术完成后立即或3小时内能够充分自主呼吸，但拔管前应进行全面的生理和临床评估，以确定那些术后需要长时间机械通气的患者。本文提出了早期拔管患者的选择标准。
