Early extubation after cardiac surgery: a prospective clinical trial including patients at risk.

BACKGROUND

Recent evidence suggests that early extubation after cardiac surgery can be performed without increased morbidity, resulting in economic advantages. However, most studies on this subject exclude patients with preoperative risk factors described as predictors for prolonged mechanical ventilation. The purpose of our prospective clinical trial was to decide whether early extubation is feasible independent of preoperative patient status, in particular independent of preoperative risk factors.

METHODS

From 12/96 to 6/97, 266 patients underwent cardiac surgery, most commonly CABG and valve replacement. 65 patients (24.4%) formed the risk group, showing preoperatively at least one of the following risk factors: emergency surgery, severe left-ventricular dysfunction, previous heart surgery, recent myocardial infarction, age 75 years or older, history of several myocardial infarctions. The remaining 201 patients (75.6%) formed the control group. The percentage of patients extubated within 12 hours represented the primary endpoint. 38 patients (10 risk, 28 control) had to be excluded from further analyses due to intra- or perioperative complications.

RESULTS

No differences between 55 risk patients and 173 control patients could be detected in extubation rate within 12 hours (100% vs 100%), mean extubation time (6:04 h vs 6:01 h), and incidence of complications after extubation (5.5% vs 5.2%). Risk patients were discharged 0.33 days later from the intensive care unit (2.00 d vs 1.67 d; p = 0.047).

CONCLUSIONS

1. All patients are basically suitable for early extubation, with the presence of preoperative risk factors used in this study being poor predictors of prolonged ventilation. 2. The necessity of prolonged ventilation is primarily determined by intra- or perioperative complications.