Early Extubation Protocol Following Valve and Coronary Artery Bypass Surgery

Williamson C, Fitton TP, Smaroff GG, Teague PD, Shaff DA, Curran JN and D’Agostino RS

Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, USA
Department of Anesthesiology, Lahey Hospital and Medical Center, USA
Comparative Effectiveness Research Institute, Lahey Hospital and Medical Center, USA

^*Correspondance to: Williamson C 

 PDF  Full Text DOI: 10.25107/2474-1647.1424

Abstract

Background: Early extubation protocols can be safely implemented in most patients undergoing coronary artery bypass surgery. We have found that these results can be replicated in patients undergoing valve surgery and combined coronary bypass and valve surgery as well.Methods: We implemented an early extubation protocol on Apr 4th, 2011. Our goal was to extubate all appropriately selected patients within 6 h after arrival to our ICU. We utilized the Society of Thoracic Surgeons Adult Cardiac Surgical Database at our institution and compared our extubation times from Jan 1st, 2008–Apr 3rd, 2011 to Apr 4th, 2011-Dec 31st, 2014. We used a chi square test to compare how many patients were extubated within 6h, before and after implementation of this quality improvement project. Fisher’s exact tests were used as well when sample sizes were small.Results: Nearly seventy percent, 1295 of 1855 patients having cardiac surgery at Lahey Hospital and Medical Center were extubated within 6h after implementing our rapid wean protocol. This was a significant improvement compared to 29%, 455 of 1570 patients prior to our quality improvement project (p<0.0001). These results were seen for coronary artery bypass as well as valve procedures including combined aortic valve replacement and coronary bypass procedures.Conclusion: An early extubation protocol can be safely implemented in patients undergoing valve and combined valve and coronary artery bypass operations with similar success rates to those having coronary artery bypass surgery alone.

Keywords

Extubation protocol; Coronary artery bypass surgery; Postoperative care; Quality care management

Cite the article

Williamson C, Fitton TP, Smaroff GG, Teague PD, Shaff DA, Curran JN, et al. Early Extubation Protocol Following Valve and Coronary Artery Bypass Surgery. Clin Surg. 2017; 2: 1424.