Early Extubation Following Coronary Artery Bypass Surgery

Silbert, Brendan; Santamaria, John; O’Brien, Jennifer L.; Blyth, Carolyn; Kelly, William; Molnar, Rowan R.

doi:10.1378/chest.113.6.1481

Cited by 98 publications

(27 citation statements)

References 14 publications

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“…In order to more effectively control these serious complications, the patients should be kept under sedation in stable, easily supervisable conditions until the occurrence of these complications cannot be ruled out, however they can become less likely. More importantly, it was anesthesiological management with high-dose opioid anesthetics which made prolonged ventilatory support of heart surgery patients necessary per se, and the time of extubation was already established intraoperatively [6-8]. By the late 1970s, however, sporadic case reports or series with small case numbers were published which pointed out the possibility of earlier extubation in heart surgery patients [3,9-12].…”

Section: Introductionmentioning

confidence: 99%

Risk factor analysis for fast track protocol failure

Kiessling

Huneke

Reyher

et al. 2013

J Cardiothorac Surg

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BackgroundThe introduction of fast-track treatment procedures following cardiac surgery has significantly shortened hospitalisation times in intensive care units (ICU). Readmission to intensive care units is generally considered a negative quality criterion. The aim of this retrospective study is to statistically analyse risk factors and predictors for re-admission to the ICU after a fast-track patient management program.Methods229 operated patients (67 ± 11 years, 75% male, BMI 27 ± 3, 6/2010-5/2011) with use of extracorporeal circulation (70 ± 31 min aortic crossclamping, CABG 62%) were selected for a preoperative fast-track procedure (transfer on the day of surgery to an intermediate care (IMC) unit, stable circulatory conditions, extubated). A uni- and multivariate analysis were performed to identify independent predictors for re-admission to the ICU.ResultsOver the 11-month study period, 36% of all preoperatively declared fast-track patients could not be transferred to an IMC unit on the day of surgery (n = 77) or had to be readmitted to the ICU after the first postoperative day (n = 4). Readmission or ICU stay signifies a dramatic worsening of the patient outcome (mortality 0/10%, mean hospital stay 10.3 ± 2.5/16.5 ± 16.3, mean transfusion rate 1.4 ± 1,7/5.3 ± 9.1). Predicators for failure of the fast-track procedure are a preoperative ASA class > 3, NYHA class > III and an operation time >267 min ± 74. The significant risk factors for a major postoperative event (= low cardiac output and/or mortality and/or renal failure and/or re-thoracotomy and/or septic shock and/or wound healing disturbances and/or stroke) are a poor EF (OR 2.7 CI 95% 0.98-7.6) and the described ICU readmission (OR 0.14 CI95% 0.05-0.36).ConclusionRe-admission to the ICU or failure to transfer patients to the IMC is associated with a high loss of patient outcome. The ASA > 3, NYHA class > 3 and operation time >267 minutes are independent predictors of fast track protocol failure.

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Section: Introductionmentioning

confidence: 99%

Risk factor analysis for fast track protocol failure

Kiessling

Huneke

Reyher

et al. 2013

J Cardiothorac Surg

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“…Improvement in cardiopulmonary performance, shorter ICU and hospital stay as well as reduction in costs could be achieved when cardiac surgical patients were weaned from mechanical ventilator at the appropriate time 8-12.On the contrary, prolonged ventilation support could have contributed to increased morbidity, mortality and cost 13-14. In this study, 81 patients out of 588 patients were extubated beyond 48 hours after CABG, with an incidence of 13.8%.…”

Section: Discussionmentioning

confidence: 72%

Risk Factors for Ventilator Dependency Following Coronary Artery Bypass Grafting

Ji¹,

Duan²,

Wang³

et al. 2012

Int. J. Med. Sci.

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Background: Ventilator dependency following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for ventilator dependency following CABG. This study aimed to evaluate the independent risk factors for ventilator dependency following coronary artery bypass grafting (CABG). Methods: The relevant pre-, intra- and post-operative data of patients without a history of chronic obstructive pulmonary disease undergoing isolated CABG from January 2003 to December 2008 in our center were retrospectively analyzed. Elapsed time between CABG and extubation of more than 48 hours was defined as postoperative ventilator dependency (PVD). Results: The incidence of PVD was 13.8% (81/588). The in-hospital mortality in the PVD group was significantly higher than that in the non-PVD group (8.6% versus 2.4%, p=0.0092). Besides the length of ICU and hospital stay, PVD correlated with negative respiratory outcomes. The independent risk factors for PVD were preoperative congestive heart failure (OR=2.456, 95%CI 1.426-6.879), preoperative hypoalbuminemia (OR=1.353, 95%CI 1.125-3.232), preoperative arterial oxygen partial pressure (PO2) (OR=0.462, 95%CI 0.235-0.783) and postoperative anaemia (OR=1.541, 95%CI 1.231-3.783). Conclusions: Preoperative congestive heart failure, preoperative hypoalbuminemia, low preoperative PO2 and postoperative anaemia were identified as four independent risk factors for ventilator dependency following CABG.

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“…27,28 Fentanyl at a dose of 10 to15 μg/kg at induction is commonly used in many centers. 2,16,17,28,24,26,30 Remifentanil was equally safe and effective as fentanyl with no difference in time to extubation. 21 We have maintained anaesthesia with propofol, isoflurane combination in the pre by-pass period.…”

Section: Methods Of Ftcamentioning

confidence: 96%

“…The most common induction agent is propofol in combination with an opioid, usually at a dose of 0.5 mg/kg with 10mg boluses until loss of consciousness 17,21,22,23,24 although some use propofol in higher doses 2,5,25 or even start directly with an infusion. 26 Etomidate, thiopentone and ketamine are described as being used. There are some centers that omit the induction agent entirely.…”

Section: Methods Of Ftcamentioning

confidence: 99%

“…Since then propofol has been used commonly in cardiac anaesthesia, either as part of a total intravenous anaesthetic technique 5,23,28 or as sedation on CPB and continuing into the ICU. 2,5,17,22,24,25,26 The most common agent used for sedation of these patients post bypass and into the ICU is propofol. 5,17,21,22,23,24,26 Some authors add midazolam either as boluses or an infusion.…”

Section: Methods Of Ftcamentioning

confidence: 99%

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