Abstract
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%), meanextubation 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.
Key words
Early extubation - Cardiac surgery - Risk patient
