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Related Experiment Video

Updated: May 1, 2026

Single-stage Dynamic Reanimation of the Smile in Irreversible Facial Paralysis by Free Functional Muscle Transfer
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Rapid awakening protocol in complex head and neck reconstruction.

Mark W Clemens1, Summer E Hanson, Samir Rao

  • 1Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Head & Neck
|March 29, 2014
PubMed
Summary

Rapid awakening protocol (RAP) offers superior outcomes for head and neck reconstruction patients compared to prolonged mechanical ventilation. This approach reduces complications and shortens hospital stays, improving patient recovery.

Keywords:
free flapshead and neck reconstructionlength of staymechanical ventilationrapid awakening protocol

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Area of Science:

  • Head and Neck Surgery
  • Critical Care Medicine
  • Microsurgery

Background:

  • Complex head and neck free flap reconstructions often require intensive care unit (ICU) mechanical ventilation.
  • Evaluating the indications and outcomes of a rapid awakening protocol (RAP) is crucial for optimizing patient care.

Purpose of the Study:

  • To compare the outcomes of patients undergoing head and neck microvascular reconstruction managed with a rapid awakening protocol (RAP) versus traditional mechanical ventilation.
  • To identify risk factors associated with complications and prolonged hospital stays in this patient population.

Main Methods:

  • Retrospective review of consecutive patients undergoing head and neck microvascular reconstructions between 2001 and 2013.
  • Comparison of complication rates and hospital stay duration between the RAP cohort and the mechanical ventilation cohort.

Main Results:

  • The RAP cohort (75 patients) experienced significantly lower overall complication rates (31%) compared to the mechanical ventilation cohort (605 patients, 61%; p < .001).
  • Mechanical ventilation, advanced age, and aerodigestive tract involvement were identified as significant risk factors for complications and longer hospital stays.
  • Multivariate analysis indicated that RAP significantly reduced the risk of complications (OR = 0.32; 95% CI = 0.19-0.54; p < .001).

Conclusions:

  • Early extubation and spontaneous breathing via a rapid awakening protocol (RAP) lead to superior recovery for select patients.
  • RAP is a beneficial alternative to prolonged mechanical ventilation in complex head and neck reconstructions, associated with fewer complications.