Early Extubation After Cardiac Surgery for the Best Respiratory Clinical Outcomes

Early Extubation After Cardiac Surgery for the Best Respiratory Clinical Outcomes.

Theresa Sheldon PA-S

Saint Francis University

July 16, 2010

Abstract

Prolonged mechanical ventilation (PMV) after heart surgery is associated with respiratory complications, morbidity, and mortality.   Decreasing the amount of time a patient is on mechanical ventilation therefore may decrease the risk the major complications associated with cardiac surgery.  The question of, in patients who just had cardiac surgery, what is the effect of early extubation after surgery compared with an extended intubation period, was researched.  Those patients who were able to have an early extubation defined as patients requiring mechanical ventilation for <12 hours, had better outcomes clinically than those patients that required a longer time.  Statistically patients who had shorter intubation times had a decrease risk of respiratory complications, respiratory infections, morbidity, or mortality.

Key words:  early extubation, early extubation in adult cardiac surgery, coronary artery bypass graft, and respiratory complications with surgery

Introduction

Respiratory failure (RF) is a major complication of cardiac surgery and is associated with an increase in morbidity and mortality (Ghosh et al., 2007).  Most studies that have been done on this topic are on simple procedures and overall healthy patients.  As medicine progress with technology, patients’ profiles are always changing, requiring constant changes in what cardiologists do in cardiac surgery and how health care providers provide care post operatively.  Over the last decade, there have been an increasing number of patients undergoing cardiac surgery who have worsening pre operative profiles due to an increase in age and multiple preoperative comorbidities.  In addition, patients are undergoing more complex procedures then in the past requiring more up to date studies (Ghosh et al., 2007). 

Many studies now believe that early extubation after all cardiac surgeries, not just coronary artery bypass graft (CABG) surgeries, should be the gold standard.  Many studies have shown that early extubation with CABG’s are very effecting in reducing respiratory complications and now the question has arose is it safe for all cardiac surgeries?  Hospitals should all have a “fast track” protocol established since early extubation is associated with improved cardiac function, increased patient comfort, and reduced respiratory complications (Cislaghi, Condemi, & Corona, 2007).  These fast track protocols should be used on every patient even if they have high risk for failure.  The quicker these patients are taken off mechanical ventilation, the better their clinical outcomes including decreased risk of respiratory complications, respiratory infections, morbidity, or mortality.  The importance of minimizing the risks associated with PMV is important to decrease the clinical outcomes of surgical patients.