Predictors of operating room extubation in adult cardiac surgery

Abstract

Perioperative factors that are independently associated with successful operating room extubation after adult cardiac operations were identified, and an operating room extubation prediction scoring system was validated. This scoring system may be used to guide safe operating room extubation after cardiac operations.

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

“…101 To this purpose, scoring systems have been proposed, and simple clinical metrics such as cross-clamp time, postoperative normothermia, and inotropic use have been directly related to successful early extubation. [102][103][104] Various anesthetic and analgesic techniques have been used effectively, the unifying principle being the optimization of patients' physiology and pharmacology to facilitate extubation. [105][106][107][108] The use of a postanesthesia or high-dependency unit as an alternative to a traditional intensive care unit for low-risk patients has been described and may encourage early extubation in a safe and cost-effective manner.…”

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

“…Indeed, evidence suggests that from a physiologic standpoint the differential effect on pulmonary function and gas exchange between immediate and early extubation is minimal. 32 The recently described scoring system by Subramaniam and colleagues, 33 intended to predict successful OR extubation after cardiac surgery, may be a useful adjunct for care providers contemplating such a decision. Notwithstanding, the only intraoperative characteristics identified by Subramaniam and colleagues 33 as predictive of successful OR extubation were fentanyl dose and use of multiple inhalational agents, which is likely reflective of an anesthetic strategy designed to facilitate earlier extubation.…”

Early extubation after cardiac surgery: The evolution continues

“…Furthermore, advances in percutaneous coronary intervention have considerably reduced the number of patients who are candidates for cardiac surgery, often leaving us to operate on the frailest and sickest patients, and those with the most complex coronary anatomy. As such, tools are needed to aid in identifying the patients who would optimally be chosen for early extubation, and that is what Subramaniam and colleagues 3 have accomplished with their development of a predictive score for successful extubation, as published in this issue of the Journal. The characteristics are in some respects very obvious (eg, younger age and simpler operation); however, one can easily make the argument that all patients, irrespective of the procedure or the patient characteristics, should be treated right from the start as if they can be extubated in the operating room.…”

“…4 Clearly not all patients will be appropriate for extubation in the operating room-for example, patients with significant obstructive sleep apnea, for whom residual opiates may further complicate the apnea, would not be ideal candidates. 5 Risk scoring systems such as that outlined by Subramaniam and colleagues, 3 however, will help guide these decisions.…”