Immediate Extubation Versus Extubation Within Six Hours: Analysis of Clinical Outcomes in The Postoperative Period of Cardiac Surgery

Abstract

The advances of the quality of anesthetics and of anesthetics techniques have facilitated the optimization of time for extubation in coronary heart disease graft. Aim: Comparison of clinical outcomes between patients extubated in the operating room and extubated patients within 6 hours after Intensive Care Unit (ICU) admission in patients undergoing cardiac surgery using extracorporeal circulation. Material and methods: A retrospective observational study of 194 patients submitted to cardiac surgery using extracorporeal circulation in one of the biggest tertiary hospitals in São Paulo. They were divided into two groups. In the first group, patient’s extubated in the operating room was composed of 95 patients. The second group of patients extubated within 6 hours of ICU admission from the intubated operating room, composed of 99 patients. We excluded 10 patients who were extubated after 6 hours of ICU admission. Results: Patients extubated in the operating room (median of 8 days, IQR 6 to 10) had shorter hospital stay time than patients extubated within 6 hours of ICU admission (median of 10 days, IQR 8 to 12.5), prevalence of similar delirium (2.0% x 2.1%), absence of pneumonia associated with mechanical ventilation (VAP) (0%), absence of non-caloric-protein readjustment (0%) and regarding safety, only one patient was reintubated for anesthetic recirculation in the group of extubated in the room and there was no difference in the rate of ICU readmission with the non-extubated group. Conclusion: In this sample of patients, we found that extubation in the room was safe. Patients extubated in the operating room immediately after cardiac surgery have a lower chance of evolving with prolonged hospitalization when compared to patients who are extubated within 6 hours of ICU admission.