EARLY VS CONVENTIONAL EXTUBATION AFTER CARDIAC-SURGERY WITH CARDIOPULMONARY BYPASS

Objectives: Sedation and ventilation overnight after cardiac surgery i s common practice, However, early extubation may be feasible with no i ncrease in postoperative complications. This study examines (1) if ear ly extubation is possible in a significant number of patients, (2) if it reduces ICU stay, and (3) if this practice increases postoperative complications. Design: Prospective, controlled, randomized clinical tr ial. Patients and methods: We randomized 404 consecutive patients to e arl, extubation (7 to 11 h postoperatively) (group A, 201 patients) or conventional extubation (between 8 and 12 AM the following day) (grou p B, 203 patients), Variables included type and severity of the diseas e, surgical risk, type of operation, operative incidences, postoperati ve complications, duration of mechanical ventilation, intubation and I CU stay, bleeding, reoperation, vasoactive drugs, and mortality. Resul ts: Groups were comparable. Extubation within the preestablished time was successful in 60.2% of patients in group A and 74.4% in group B. M edian ICU stay was 27 h in group A and 44 h in group B (p=0.008), Disc harge from ICU within the first 24 h postoperatively was 44.3% in grou p A and 30.5% in group B (p=0.006). There was no significant differenc e in complications between groups. Successfully extubated patients in group A had more reintubation and prolonged ventilation than in group B. Conclusions: (1) Sixty percent of our patients were extubated nithi n 11 h of operation, (2) As a result, the length of stay in ICU was re duced and the percentage of patients discharged within 24 h was increa sed, (3) There was no increase in clinically important postoperative c omplications.