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J Thorac Cardiovasc Surg. 2017 Nov;154(5):1656-1665.e2. doi: 10.1016/j.jtcvs.2017.05.107. Epub 2017 Jun 13.

Predictors of operating room extubation in adult cardiac surgery.

Author information

1
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: subramaniamk@upmc.edu.
2
Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pa.
3
Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa.
4
University of Pittsburgh School of Medicine, Pittsburgh, Pa.
5
Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.

Abstract

OBJECTIVE:

The primary objective of the study was to identify perioperative factors associated with successful immediate extubation in the operating room after adult cardiac surgery. The secondary objective was to derive a simplified predictive scoring system to guide clinicians in operating room extubation.

METHODS:

All 1518 patients in this retrospective cohort study underwent standardized fast-track cardiac anesthetic protocol during adult cardiac surgery. Perioperative variables between patients who had successful extubation in the operating room versus in the intensive care unit were retrospectively analyzed using both univariate and multivariable logistic regression analyses. A predictive score of successful operating room extubation was constructed from the multivariable results of 800 patients (derivation set), and the scoring system was further tested using a validation set of 398 patients.

RESULTS:

Younger age, lower body mass index, higher preoperative serum albumin, absence of chronic lung disease and diabetes, less-invasive surgical approach, isolated coronary bypass surgery, elective surgery, and lower doses of intraoperative intravenous fentanyl were independently associated with higher probability of operating room extubation. The extubation prediction score created in a derivation set of patients performed well in the validation set. Patient scores less than 0 had a minimal probability of successful operating room extubation. Operating room extubation was highly predicted with scores of 5 or greater.

CONCLUSIONS:

Perioperative factors that are independently associated with successful operating room extubation after adult cardiac operations were identified, and an operating room extubation prediction scoring system was validated. This scoring system may be used to guide safe operating room extubation after cardiac operations.

KEYWORDS:

adult cardiac surgery; extubation; perioperative management

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