Rapid awakening protocol in complex head and neck reconstruction

Abstract

Patients undergoing complex head and neck free flap reconstructions are commonly maintained on mechanical ventilation in an intensive care unit (ICU). This study reviews indications and outcomes of such patients undergoing a rapid awakening protocol (RAP). We retrospectively reviewed consecutive patients who underwent head and neck microvascular reconstructions by a single surgeon between 2001 and 2013. Seventy-five patients underwent RAP and 605 received mechanical ventilation. Overall complications were significantly higher in mechanical ventilation patients than in the RAP cohort (61% vs 31%, respectively; p < .001). Univariate analysis demonstrates mechanical ventilation, age, and aerodigestive tract involvement are significant risk factors for a complication and longer hospital stay. Multivariate logistic regression model demonstrates RAP patients had significantly less risk of a complication (odds ratio [OR] = 0.32; 95% [CI] = 0.19-0.54; p < .001). The recovery of select patients with early extubation/spontaneous breathing is superior to maintenance on mechanical ventilation.