Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients

Flynn and colleagues evaluated their center’s implementation of a protocol for extubation within six hours after cardiac surgery, focusing on the rate of adverse events before and after protocol implementation particularly for those patients at highest surgical risk. The authors analyzed prospectively-collected data for patients undergoing cardiac operations within six months of the initiation of the early extubation protocol, 181 patients before and 152 after. They found no differences in the total number of adverse events (renal failure, reintubation, 30-day mortality, or postoperative stroke) before and after the protocol was initiated (16% versus 19%, p = 0.557). In a subset analysis focusing specifically on patients with STS predicted morbidity or mortality score over 40% (8 patients before, 6 patients after the protocol began), the number of adverse events were not different and the median ventilation time was reduced to less than six hours.
The authors conclude that these results are encouraging but merit further investigation, considering the small sample size.