Optimizing timing of early extubation in coronary artery bypass surgery patients

This study was designed to assess the safety and efficacy of extubation performed within 4 hours of the patient's arrival in the surgical intensive care unit after coronary artery bypass graft surgery.

A matched retrospective cohort study was performed including 412 consecutive patients undergoing isolated coronary artery bypass graft surgery between January 1996 and December 1997, constituting the experience of a single surgeon (J.H.L.). Early extubation (defined as extubation within 8 hours of arrival at the surgical intensive care unit) was achieved in 308 of 412 patients (75%). Patients extubated in fewer than 4 hours after arrival (n = 200) were compared with patients extubated within 4 to 8 hours (n = 108).

Four deaths occurred in 412 patients, for an overall operative mortality rate of 1.0%. Patients extubated in fewer than 4 hours were younger than those extubated 4 or more hours after admission (62 versus 67 years old, respectively; p = 0.001), more likely to be male (74% versus 63%, p < 0.05), and had shorter aortic cross-clamp times (49.4 +/- 15.0 versus 53.5 +/- 14.0 minutes, p < 0.05) and cardiopulmonary bypass (CPB) times (65.2 +/- 18.6 versus 72.1 +/- 19.1 minutes, p < 0.05) compared to patients extubated later. Moreover, patients extubated in fewer than 4 hours had a shorter surgical intensive care unit length of stay (33.8 +/- 25.7 versus 43.1 +/- 43.0 hours, p < 0.05) and shorter postoperative length of stay (5.4 +/- 2.4 versus 6.2 +/- 2.6 days, p = 0.01) than those extubated later.

Extubation in fewer than 4 hours may offer a substantial advantage in terms of accelerated recovery compared with extubation within 4 to 8 hours. Very few differences in clinical parameters were noted between the two groups we studied, suggesting that efforts to reduce extubation times further might be worthwhile.