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Criteria for Early Extubation After Intracardiac Surgery in Adults

OMAR PRAKASH, MD^*, BJORN JONSON, MD, SIMON MEIJ, MSc, EGBERT BOS, MD, PAUL G. HUGENHOLTZ, MD^||, JAN NAUTA, MD, and WILLEM HEKMAN, MD^*

*Senior Anaesthetist, Department of Anesthesiology, Thorax Center, University Hospital and Erasmus University, Rotterdam, The Netherlands. Senior Clinical Physiologist, Department of Clinical Physiology, University of Lund, Lund, Sweden, Thorax Center, University Hospital and Erasmus University, Rotterdam, The Netherlands. Computer Engineer, Thorax Center, University Hospital and Erasmus University, Rotterdam, The Netherlands. Professor of Cardiac Surgery, Thorax Center, University Hospital and Erasmus University, Rotterdam, The Netherlands. ||Professor of Cardiology, Thorax Center, University Hospital and Erasmus University, Rotterdam, The Netherlands.

Abstract

Of 142 adult patients undergoing open-heart surgery, 123 were extubated either in the operating room or within 3 hours after admission to the recovery room, to avoid the discomfort and risks of prolonged mechanical ventilation. The remaining 19 patients, who had impaired cardiac function, were mechanically ventilated for 1 to 7 days postoperatively. The most important criteria for cardiopulmonary malfunction indicating the need for continued mechanical ventilation were a low mixed venous O₂ saturation (S–_VO2.) of < 60% and a high left atrial pressure (>20 torr). Of the 123 patients, 118 had an uneventful postoperative recovery and 5 needed reintubation, 2 because of low S–_VO2 and 3 because of complications unrelated to respiratory management.

Most adult patients can spontaneously breathe adequately immediately after or within 3 hours of completed open-heart surgery, but a thorough physiologic and clinical evaluation should precede extubation, to identify those who need prolonged mechanical ventilation in the postoperative phase. Criteria for selection of patients for early extubation are presented.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999