Association of earlier extubation and postoperative delirium after coronary artery bypass grafting

Moran, Hellmuth R. Muller; Maguire, Duncan; Maguire, Doug; Kowalski, Stephen; Jacobsohn, Eric; Mackenzie, Scott C; Grocott, Hilary P.; Arora, Rakesh C.

doi:10.1016/j.jtcvs.2019.03.047

Cited by 13 publications

(5 citation statements)

References 31 publications

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“…Retrospective studies found patients intubated for shorter periods of time were at lower risk of death [ 30 ], had shorter stays in both the ICU and the hospital [ 30 , 31 ]. and were at lower risk for the development of delirium [ 30 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

Association of immediate versus delayed extubation of patients admitted to intensive care units postoperatively and outcomes: A retrospective study

et al. 2023

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Aim of this study This study seeks to investigate, whether extubation of tracheally intubated patients admitted to intensive care units (ICU) postoperatively either immediately at the day of admission (day 1) or delayed at the first postoperative day (day 2) is associated with differences in outcomes. Materials and methods We performed a retrospective analysis of data from an Austrian ICU registry. Adult patients admitted between January 1st, 2012 and December 31st, 2019 following elective and emergency surgery, who were intubated at the day 1 and were extubated at day 1 or day 2, were included. We performed logistic regression analyses for in-hospital mortality and over-sedation or agitation following extubation. Results 52 982 patients constituted the main study population. 1 231 (3.3%) patients extubated at day 1 and 958 (5.9%) at day 2 died in hospital, 464 (1.3%) patients extubated at day 1 and 613 (3.8%) at day 2 demonstrated agitation or over-sedation after extubation during ICU stay; OR (95% CI) for in-hospital mortality were OR 1.17 (1.01–1.35, p = 0.031) and OR 2.15 (1.75–2.65, p<0.001) for agitation or over-sedation. Conclusions We conclude that immediate extubation as soon as deemed feasible by clinicians is associated with favourable outcomes and may thus be considered preferable in tracheally intubated patients admitted to ICU postoperatively.

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Section: Discussionmentioning

confidence: 99%

Association of immediate versus delayed extubation of patients admitted to intensive care units postoperatively and outcomes: A retrospective study

et al. 2023

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“…Moran Muller and colleagues 4 provide intriguing, thought-provoking insight into coronary artery bypass grafting (CABG) and the broad implications regarding protocol-driven practice, early recovery following cardiac surgery, and the expeditious restoration of natural physiology. 4 Their retrospective review included 2561 patients who had undergone isolated CABG in a single institution. The authors evaluated the time to extubation and the impact on the incidence of delirium, stratifying time to extubation as within the operating room (OR) (0 hours), "early" (1-12 hours) post-CABG, and "late" (12-24 hours) post-CABG.…”

Section: Earlier Recovery After Bypassmentioning

confidence: 99%

“…3 In the same vein, the promotion of early extubation in the prevention of delirium underscores the importance of maintaining neurologic integrity in the context of critical care delivery. 4 The Other Epidemic…”

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confidence: 99%

2020 in review

Hayanga

Likosky

Diepen

et al. 2021

The Journal of Thoracic and Cardiovascular Surgery

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“…Одним з пунктів післяопераційного менеджменту є тривалість штучної вентиляції легень. Згідно з fast-trackпротоколом рекомендовано екстубувати пацієнта впродовж перших 6 годин після оперативного втручання, що значно скорочує тривалість перебування пацієнтів у ВІТ [4]. Однак не розроблено рекомендацій, яку тактику седації обрати.…”

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Effect of Sedation Strategy on the Hospital Length of Stay and ICU Length of Stay after On-Pump Cardiac Surgeries

PLECHYSTA

Дубров

2023

ujcvs

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Over the past decades, many approaches have been changed in intensive care and in anesthesiology. Most of these changes were included in the guidelines now well known as fast-track protocols (protocols for enhanced recovery after surgery). Cardiac anesthesiology was not an exception. Preoperative, intraoperative and postoperative management of the patient are the main components of these protocols, which are aimed at reducing the length of stay (LOS) of patients in the hospital and intensive care units (ICU). The aim. To detect the relationship between the sedation strategy and the duration of the hospital LOS and the ICU LOS. Materials and methods. This was a randomized, controlled, parallel study. We analyzed 194 patients over 18 years of age who underwent cardiac surgical treatment using artificial blood circulation. Statistical data processing was carried out on the basis of GraphPad Prism 9.0 software. Results. According to our research, the average hospital LOS was 7.779 ± 2.844 days in the propofol group (n = 95), 7.188 ± 1.601 days in the dexmedetomidine group (n = 16). In the group where patients were sedated with a combination of drugs (n = 83), the average length of hospitalization was 5.904 ± 1.535 days. The average ICU LOS was 2.463 ± 1.090 days in the propofol group and 2.375 ± 1.360 days in the dexmedetomidine group. In the group where patients were sedated with a combination of drugs (n = 83), the average ICU LOS was 2.361 ± 0.8776 days. The hospital LOS of patients who were sedated with a combination of drugs was lower (p < 0.0001). When comparing the ICU LOS, no difference was found in all three sedation groups (p = 0.3903). According to the analysis conducted in the propofol group, the ICU LOS was shorter in patients who did not receive vasoactive therapy (p = 0.0299). In the dexmedetomidine sedation group, no difference was found between the ICU LOS in patients with or without vasoactive support (p = 0.5289). In the group of patients who underwent sedation with a combination of drugs, the ICU LOS was shorter in the group of patients who underwent correction with vasoactive drugs (p < 0.0001). Conclusion. Sedation with a drug combination (dexmedetomidine and propofol) may reduce hospital LOS (p < 0.0001). There was no influence of any sedation strategy on the ICU LOS (p = 0.3903). Early initiation of vasoactive support with sedative drug combination (dexmedetomidine and propofol) shortens the ICU LOS (p < 0.0001).

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Association of earlier extubation and postoperative delirium after coronary artery bypass grafting

Cited by 13 publications

References 31 publications

Association of immediate versus delayed extubation of patients admitted to intensive care units postoperatively and outcomes: A retrospective study

Association of immediate versus delayed extubation of patients admitted to intensive care units postoperatively and outcomes: A retrospective study

2020 in review

Effect of Sedation Strategy on the Hospital Length of Stay and ICU Length of Stay after On-Pump Cardiac Surgeries

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