The Lack of Benefit of Tracheal Extubation in the Operating Room After Coronary Artery Bypass Surgery

Abstract

Although early tracheal extubation in cardiac anesthesia is safe and cost beneficial, questions still remain regarding how early after cardiac surgery patients should be tracheally extubated (TE). Our objective was to determine the effects on resource use if patients scheduled for coronary artery bypass grafting have TE in the operating room (OR). We studied 100 consecutive patients undergoing elective coronary artery bypass grafting, requiring extracorporeal circulation, and those eligible for a fast-track pathway. At the end of the procedure, the patients were evaluated for TE in the OR if they were hemodynamically stable, were without significant bleeding, and fulfilled clinical and blood gas analysis variables. Patients who did not meet the requirements had TE in the intensive care unit (ICU). Fifty patients had TE in the OR and 50 patients in the ICU. Time in the OR after skin closure, ICU length of stay, and postoperative length of stay were similar between the groups. Four patients (8%) in the OR group were tracheally reintubated secondary to respiratory depression (P = 0.11). Three patients (6%) in the OR group had postoperative myocardial infarction, and one postoperative myocardial infarction (2%) occurred in the ICU group (P = 0.61). All four patients recovered satisfactorily. The incidences of other complications were similar between groups. Implications Tracheal extubation in the operating room after uncomplicated coronary artery bypass grafting is not associated with significantly decreased intensive care unit and postoperative length of stay. This practice is, however, associated with a moderate risk of reintubation.