Factors that influence early extubation: Bleeding

Excessive bleeding after cardiac surgery is an important factor that can pr event early extubation. Hemostatic derangement is well recognized to be ass ociated with cardiopulmonary bypass, with many possible contributing factor s resulting in coagulation defects and fibrinolytic pathway activation. Mea sures to optimize hemostasis are critical whin managing patients for whom e arly extubation and hospital discharge are goals. The intraoperative evalua tion of the hemostatic system with tests like the thrombelastogram and the use of therapeutic agents such as aprotinin are simple, safe, and effective methods of achieving these goals. Copyright (C) 1998 by W.B. Saunders Comp any.