Pro: Early extubation after cardiac surgery decreases intensive care unit stay and cost

Cheng, Davy

doi:10.1016/s1053-0770(05)80105-3

Cited by 93 publications

(29 citation statements)

References 36 publications

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“…1998). The results indicate no increase in morbidity and a decreased length of hospital stay, with obvious cost containment implications (Cheng 1995;Guenther 1995) for patients in the early extubation groups, as compared with those who underwent conventional extubation (Cheng et al . 1996a;Silbert et al .…”

Section: Extubation Following Cardiac Surgerymentioning

confidence: 99%

Evidence‐based practice – an incomplete model of the relationship between theory and professional work

Hancock

Easen

2004

Evaluation Clinical Practice

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Section: Extubation Following Cardiac Surgerymentioning

confidence: 99%

Evidence‐based practice – an incomplete model of the relationship between theory and professional work

Hancock

Easen

2004

Evaluation Clinical Practice

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“…This practice is primarily driven by the need to reduce cost and improve resource utilization by eliminating unnecessary medical interventions and care 2, 3. Large and multiinstitutional randomized controlled studies confirm that extubation of patients within 8 hours after cardiac surgery reduces cost by decreasing intensive care unit and hospital length of stay 1–4. The failure of early extubation to influence morbidity and mortality in these study groups provides robust evidence for the broader adoption of early extubation in other patient populations as a cost‐effective practice that does not compromise patient outcome 4…”

mentioning

confidence: 96%

A multicenter evaluation of safety of early extubation in liver transplant recipients

et al. 2007

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Small single-institutional studies performed prior to the introduction of organ allocation using the Model for End-Stage Liver Disease (MELD) suggest that early airway extubation of liver transplant recipients is a safe practice. We designed a multicenter study to examine adverse events associated with early extubation in patients selected for liver transplantation using MELD score. A total of 7 institutions extubated all patients meeting study criteria and reported adverse events that occurred within 72 hours following surgery. Adverse events were uncommon: occurring in only 7.7% of 391 patients studied. Most adverse events were pulmonary or surgically related. Pulmonary complications were usually minor, requiring only an increase in ambient oxygen concentration. The majority of surgical adverse events required additional surgery. Analysis of a limited set of perioperative variables suggest that blood transfusions and technical factors were associated with an increased risk of adverse events. In conclusion, while early extubation appears to be safe under specified circumstances, there are performance differences between institutions that remain to be explained. Liver Transpl 13:1557Transpl 13: -1563Transpl 13: , 2007

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“…Driven by economic reasons, it is better in cardiac surgery to extubate patients during the immediate postoperative period [18]. However, in patients undergoing cardiac surgery, perioperative myocardial ischemia (diagnosed by electrocardiography and/or transesophageal echocardiography) is most commonly observed during this time (25%-38% incidence) and is likely related to outcome [19].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Combined Intrathecal Morphine and Clonidine on Stress Response, Extubation Time and Postoperative Analgesia after Cardiac Surgery

Mogahed¹,

Hamed²,

Elkahwagy³

2017

J Anesth Clin Res

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Background: Pain is a major complication after cardiac surgery, if it is poorly controlled, it will lead to more complication as respiratory depression, myocardial ischemia, delayed extubation, and more ICU stay, with the more analgesic consumption and patients suffering. Intrathecal morphine produces intense and prolonged analgesia and can be useful adjunct for controlling postoperative pain and facilitating early extubation after cardiac surgery. The addition of intrathecal clonidine to morphine allows the dose of intrathecal morphine to be reduced and reduces the risk of respiratory depression while maintaining good analgesia and allows early extubation. This randomized controlled study was carried out on 40 patients undergoing open cardiac surgery and was divided into two groups; group (I): is the control group (n=40) and group (II): is the morphine clonidine group (n=40), patients received intrathecal morphine 4 mcg/kg and clonidine 1 mic/kg. The aim of this study was to evaluate the effects of combined intrathecal morphine and clonidine on stress response, time of extubation, and postoperative analgesia after cardiac surgery. The results of our study revealed that, there was no statistical significant changes in CVP (central venous pressure), Sao 2 (Oxygen saturation) and lactate level in both group, but there was a decrease in HR after induction and before bypass in the intrathecal morphine clonidine group compared with the control one, also there was a significant reduction in MAP after induction, before bypass and after bypass in morphine clonidine group vs. control group. Cortisol level was decreased after sternotomy, after ICU admission and after extubation in the morphine group vs. control group. Time to extubation, vas, and morphine consumption in 24 h were all decreased in the morphine group compared with the control one, with no significant differences in post-operative complication in both studied groups.

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Pro: Early extubation after cardiac surgery decreases intensive care unit stay and cost

Cited by 93 publications

References 36 publications

Evidence‐based practice – an incomplete model of the relationship between theory and professional work

Evidence‐based practice – an incomplete model of the relationship between theory and professional work

A multicenter evaluation of safety of early extubation in liver transplant recipients

The Effect of Combined Intrathecal Morphine and Clonidine on Stress Response, Extubation Time and Postoperative Analgesia after Cardiac Surgery

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