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Factors determining the duration of tracheal intubation in cardiac surgery: a single-centre sequential patient audit

Published online by Cambridge University Press:  02 June 2005

C. Naughton ,
N. Reilly ,
A. Powroznyk ,
C. Aps ,
T. Hunt ,
D. Hunter ,
R. S. Parsons ,
E. Sherry ,
D. Spackman  and
A. Wielogorski
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C. Naughton
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
N. Reilly
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
A. Powroznyk
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
C. Aps
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
T. Hunt
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
D. Hunter
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
R. S. Parsons
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
E. Sherry
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
D. Spackman
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
A. Wielogorski
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
R. O. Feneck
Affiliation:
St Thomas' Hospital NHS Trust, London, UK
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Extract

Summary

Background and objective: The study was designed to identify those factors associated with early tracheal extubation following cardiac surgery. Previous studies have tended to concentrate on surgery for coronary artery bypass or on other selected cohorts.

Methods: Sequential cohort analysis of 296 unselected adult cardiac surgery patients was performed over 3 months.

Results: In total, 39% of all patients were extubated within 6 h, 89% within 24 h and 95% within 48 h. Delayed extubation (>6 h after surgery) appeared unrelated to age, gender, body mass index, a previous pattern of angina or myocardial infarction, diabetes, preoperative atrial fibrillation, and preoperative cardiovascular assessment, as well as other factors. Delayed tracheal extubation was associated with poor left ventricular, renal and pulmonary function, a high Euroscore, as well as the type, duration and urgency of surgery. Early extubation (<6 h) was not associated with a reduced length of stay in either the intensive care unit or in hospital compared with patients who were extubated between 6 and 24 h. In these groups, it is presumed that organizational and not clinical factors appear to be responsible for a delay in discharge from intensive care. Patients who were extubated after 24 h had a longer duration of hospital stay and a greater incidence of postoperative complications. Postoperative complications were not adversely affected by early tracheal extubation.

Conclusions: In an unselected sequential cohort, both patient- and surgery-specific factors may be influential in determining the duration of postoperative ventilation of the lungs following cardiac surgery. In view of the changing nature of the surgical population, regular re-evaluation is useful in reassessing performance.

Keywords

INTUBATION, intubation, intratrachealQUALITY OF HEALTH CARE, medical auditSPECIALTIES SURGICAL, thoracic surgery
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 3 , March 2003 , pp. 225 - 233
Copyright
© 2003 European Society of Anaesthesiology

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References

Spencer FC, Benson DW, Liu WC, Bahnson HT. Use of mechanical respirator in the management of respiratory insufficiency following trauma or operation for cardiac or pulmonary disease. J Thorac Cardiovasc Surg 1959; 38: 758–770.Google Scholar
Ditzeitlin GL. Artificial respiration after cardiac surgery. Anaesthesia 1965; 20: 145–156.Google Scholar
Cooperman L, Mann PE. Postoperative respiratory care: a review of 65 consecutive of open heart surgery on the mitral valve. J Thorac Cardiovasc Surg 1967; 53: 504–509.Google Scholar
Lefemine AA, Harken DE. Postoperative care following open heart operations: routine use of controlled ventilation. J Thorac Cardiovasc Surg 1966; 52: 207–216.Google Scholar
Sykes MK, Adams AP, McCormick PW, Bird B, Greenburgh S. The effect of mechanical ventilation after open-heart surgery. Anaesthesia 1970; 25: 525–540.Google Scholar
Lowenstein E, Hallowell P, Daggett WM, Austen WG, Laver MB. Cardiovascular response to large doses of intravenous morphine in man. N Engl J Med 1969; 281: 1389–1393.Google Scholar
Arens JF, Benbow BP, Ochsner JL, Therd R. Morphine anesthesia for aortocoronary bypass procedures. Anesth Analg 1972; 51: 901–909.Google Scholar
Sanford TJ Jr, Smith NT, Dec Silver H, Harrison WK. A comparison of morphine, fentanyl and sufentanil anaesthesia for cardiothoraic emergency and extubation. Anaesth Analg 1986; 65: 259–266.Google Scholar
De Lange S, Boscoe MJ, Stanley TH, Pace N. Comparison of sufentanil–O2 and fentanyl–O2 for coronary artery surgery. Anesthesiology 1982; 56: 112–118.Google Scholar
Truman KJ, McCarty RJ, el Ganzouri AR, Spiess BD, Ivankovich AB. Sufentanil–midazolam anesthesia for coronary artery surgery. J Cardiothorac Anesth 1990; 4: 308–313.Google Scholar
De Lange S, Stanley TH, Boscoe MJ. Alfentanil–oxygen anaesthesia for coronary artery surgery. Br J Anaesth 1981; 53: 1291–1296.Google Scholar
Tuman KJ, McCarthy RJ, Spiess BD, DaValle M, Dabir R, Ivankovich AD. Does choice of anaesthetic agent significantly affect outcome after coronary artery bypass surgery. Anesthesiology 1989; 70: 189–198.Google Scholar
Slogoff S, Keats AS. Randomised trial of primary anesthetic agents on outcome of coronary artery surgery. Anesthesiology 1989; 70: 179–188.Google Scholar
Cheng DC. Fast-track cardiac surgery, economic implications in postoperative care. J Cardiothorac Vasc Anesth 1998; 12: 72–79.Google Scholar
Chong JL, Pillai R, Fisher A, Grebenik C, Sinclair M, Westaby S. Cardiac surgery moving away from intensive care. Br Heart J 1992; 68: 430–433.Google Scholar
Westaby S, Pillai R, Parry A, Giannopoulos N, Grebenik C, Sinclair M. Does modern cardiac surgery require conventional intensive care. Eur J Cardiothorac Surg 1993; 7: 313–318.Google Scholar
Hutter JA, Aps C, Hemsi D, Williams BT. The management of cardiac surgical patients in a general surgical recovery. J Cardiovasc Surg 1989; 30: 273–276.Google Scholar
Aps C. Fast-tracking in cardiac surgery. Br J Hosp Med 1995; 54: 139–142.Google Scholar
Altman DG. Preparing to analyse data. In: Bland J, Altman DG, eds. Practical Statistics for Medical Research. London, UK: Chapman & Hall, 1999.
Huber PJ. The behaviour of maximum likelihood estimates under non-standard conditions. In: Proceedings of the 5th Berkeley Symposium in Mathematical Statistics and Probability. Berkeley, USA: University of California Press, 1967: 221–233.
Roques F, Nashef SA, Michel P, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 1999; 15: 816–822; discussion: 822–823.Google Scholar
Lee TWR, Jacobsohn E. Pro: tracheal extubation should occur routinely in the operating room after cardiac surgery. J Cardiothorac Vasc Anesth 2000; 14: 603–610.Google Scholar
London MJ, Shroyer AL, Coll JR. Early extubation following cardiac surgery in a veterans population. Anesthesiology 1998; 88: 1447–1158.Google Scholar
Cheng DC. Anesthetic techniques and early extubation: does it matter? J Cardiothorac Vasc Anesth 2000; 14: 627–631.Google Scholar
Aps C, Hutter JA, Williams BT. Anaesthetic management and postoperative care of cardiac surgical patients in a general recovery ward. Anaesthesia 1986; 41: 533–537.Google Scholar
Moldenhauser CC. New narcotics. In: Kaplan JA, ed. Cardiac Anesthesia, Vol. 2. New York, USA: Grune & Stratton, 1983: 31–79.