Impact of immediate versus delayed tracheal extubation on length of ICU stay of cardiac surgical patients, a randomized trial

Abstract

Introduction: Ultra-fast track anaesthesia aims at immediate extubation of cardiac surgical patients at the end of the operation. This study compares the effect of ultrafast track anesthesia versus continued postoperative mechanical ventilation on the intensive care unit length of stay.

Methods: Fifty-two elective adult patients were randomly allocated into ultrafast track anaesthesia and conventional groups by computer-generated random numbers. Redo operations, pre-operative intubation, uncontrolled diabetes, shock/left ventricular ejection fraction < 45%, pulmonary artery systolic pressure >55mmHg, creatinine clearance -1, haemodynamic instability, or those with concerns of postoperative bleeding were excluded. Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all. Intra-operatively, haemodynamic parameters, urine output, oxygen saturation, arterial blood gas analysis, 5-lead electrocardiogram, operative bypass- and cross-clamp time, and opioid consumption were collected. Postoperatively, patients were compared during their intensive care unit stay. Data were analysed by χ²/Fischer exact, unpaired student's t-test, univariate two-group repeated measures with post hoc Dunnett's test, and Mann-Whitney U tests as appropriate. p < 0.05 was considered significant.

Results: Patients were comparable regarding their peri-operative characteristics and EuroSCORE. The intensive care unit stay was shorter in the ultrafast track anaesthesia group [57.4 (18.6) vs. 95 (33.6) h. p < 0.001], without increasing postoperative renal, respiratory complications rate or reopening rate.

Conclusions: In this single center study, ultrafast track anaesthesia decreased intensive care unit stay without increasing the rate of post-operative complications.

Keywords: ICU stay; cardiac anaesthesia; ultra fast track anaesthesia.

Table 1

Perioperative diagnosis, operation, demographic data, co-morbidities, and lab findings. Data are presented as number (percentages), mean (SD) as appropriate. UFTA = ultra-fast track anesthesia; CHD = congenital heart disease; IHD = ischemic heart disease; RHD = rheumatic heart disease; ASD = atrial septal defect; AVR = aortic valve replacement; CABG = coronary artery bypass graft; MVR = mitral valve replacement; TVR = tricuspid valve replacement; VSD = ventricular septal defect; BMI = body mass index; SD = standard deviation; HTN = hypertension; DM = diabetes mellitus; COPD = chronic obstructive pulmonary disease; PHT = pulmonary hypertension; EF = ejection fraction; Hb = hemoglobin; Euroscore = European System for Cardiac Operative Risk Evaluation.

Table 2

Intraoperative hemodynamics, ABG findings, intraoperative findings, and opioid usage. Data are presented as mean (standard deviation). UFTA = ultra-fast track anesthesia; SD = standard deviation; MAP = mean arterial pressure;  HR = heart rate; CVP = central venous pressure; SpO₂ = arterial oxygen saturation; ABG = arterial blood gas;  pH = power of hydrogen; PO₂ = arterial oxygen tension; PCO₂ = arterial carbon dioxide tension; HCO₃ = bicarbonate; OP = operative; CPB = cardiopulmonary bypass; AXC = aortic cross clamp.

Table 3

Postoperative ICU course, pain score, and postoperative complications. Data are presented as mean (standard deviation), frequency (percentage) as appropriate. UFTA = ultra-fast track anesthesia; SD = standard deviation; ICU = intensive care unit; VAS = visual analogue score.