Early extubation: preliminary experience in the cardiothoracic patient population

Abstract

BACKGROUND: Changing trends and economic forces that emphasize reduced length of stay and early discharge have commanded the need for redesign in the perioperative management of cardiovascular surgical patients. In an effort to explore alternative strategies a multidisciplinary group developed an early extubation program. OBJECTIVES: To determine the safety and efficacy of early extubation in terms of patient outcome, satisfaction and psychologic recovery, and cost and resource utilization. METHODS: A prospective analysis was conducted on patients who met eligibility criteria. Data were acquired from the medical record and through patient interviews. RESULTS: Forty-seven patients successfully participated in the early extubation program over a 10-month period; 15% were older than 70 years. The incidence of reintubation, cardiac arrest, or death was zero. The mean postoperative length of stay was 5.8 days. Two thirds of patients completed a one-step transfer model conferring a modest cost reduction and improved resource utilization. Findings also demonstrated reduced weight gain, earlier mobilization, and improved psychologic recovery. CONCLUSIONS: The preliminary findings demonstrate that early extubation is a safe and effective practice in selected cardiovascular surgical patients. Factors such as rising acuity, advanced age, and multisystem disease must be considered. Further research is warranted to validate the continued safety and efficacy of this practice to ensure positive patient outcomes.