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Trials Comparing Early vs Late Extubation Following Cardiovascular Surgery^*

^* From the Departments of Medicine (Drs. Meade and Guyatt) and Clinical Epidemiology & Biostatistics (Ms. Griffith), McMaster University, Hamilton, Ontario, Canada; the Department of Anesthesia (Dr. Butler), University of Western Ontario, London, Ontario, Canada; and the Department of Respiratory Therapy (Messrs. Elms and Ingram, and Ms. Hand), Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada.

Correspondence: Deborah J. Cook, MD, McMaster University, Faculty of Health Sciences Center, Department of Clinical Epidemiology & Biostatistics, 1200 Main St West, Hamilton, Ontario, Canada; e-mail: debcook{at}mcmaster.ca

We identified 10 randomized trials that compared alternative management approaches to patient care during and following cardiovascular surgery. One overall strategy involved a modification of anesthesia, in particular, a reduction in the dosage of fentanyl and benzodiazepine or the substitution of fentanyl for propofol (five randomized controlled trials [RCTs]). Pooled results show a shorter duration of ventilation (7 h) and a shorter duration of hospital stay (approximately 1 day) associated with lower anesthetic doses. The second strategy involved early vs late extubation once patients were admitted to the ICU (five RCTs). Pooled results show a shorter duration of ventilation (13 h) and a shorter duration of ICU stay (half a day) associated with early extubation. An additional 8 nonrandomized trials had findings that were consistent with the 10 RCTs. Reintubation, complications, and mortality rates were too low to draw conclusions about these outcomes. Overall, these studies indicate that anesthetic, sedation, and early-extubation strategies in selected cardiac surgery patients are associated with a shorter duration of mechanical ventilation and shorter lengths of ICU and hospital stays.

Key Words: cardiac surgery • coronary artery bypass • early extubation • extubation • mechanical ventilation • meta-analysis • systematic reviews • weaning

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