Early extubation after heart surgery

Objective

To analyze early extubation of patients submitted to heart surgery while in the ICU.

Materials and methods

Aleatory and prospective analysis of patients submitted to heart surgery and early extubation immediately post operation, with other aspects being studied such as: clinical evolution, cardiopulmonary complications, time of stay in the ICU and complications related to early extubation. As criteria for inclusion, the main determining factors were hemodynamic stability, consciousness level (Ramsay >3), motor function preservation, normal radiologic pattern and PO₂/FiO₂ ratio >250. After 1 hour of ICU arrival, patients were submitted to superficialization of the consciousness level with an antagonist of benzodiazepinics, and then nebulization with a 'T' piece for 30 min, following extubation, and then intermittent noninvasive ventilation support (CPAP). All of the patients were monitored with pulse oximetry, series of gas analysis, clinical evaluation and radiologic control.

Results

Out of the total number of patients analyzed (n = 100), 72% were male. Regarding the type of surgery, there was a higher prevalence of patients submitted to CABG (83%); other types such as valve surgeries and congenital corrections totaled 17%. The average time for extubation was 2 hours (ICU arrival until extubation), and the average period of nebulization was 30 min. In this group, 4% went through reintubation because of somnolence. There were no deaths among the patients studied.

Conclusion

The determination of specific protocols for early extubation facilitates a satisfactory evolution with less morbidity among patients submitted to heart surgery.