Early Tracheal Extubation after On-Pump Coronary Artery Bypass Grafting

Manabu Sato, MD,1 Etsuro Suenaga, MD,1 Shugo Koga, MD,1 Shigefumi Matsuyama, MD,1 Hiromitsu Kawasaki, MD,1 and Fumie Maki, MD2

Objective: A fast-track recovery in cardiac surgery yields many benefits, and early tracheal extubation is important as the first step. The purpose of this study is to evaluate the status of early tracheal extubation after on-pump coronary artery bypass grafting (CABG) and to find key factors for successful early tracheal extubation.
Methods: From September 1996 to February 2005, isolated on-pump CABG was performed on 485 patients, and an early tracheal extubation protocol was employed on all. It was defined as tracheal extubation within 6 hr of arrival in the intensive care unit (ICU).
Results: An early tracheal extubation was successful on 450 patients (92.5%). Reintubation was necessary in 5 (1.1%) because of a resternotomy for bleeding in 3 and ventricular arrhythmia in 2. Mechanical ventilation exceeding 24 hours was required in 7 patients (1.4%) because of heart failure in 4 and respiratory failure in 3. Significant factors of successful early tracheal extubation were the European System for Cardiac Operative Risk Evaluation (P <0.05), the number of diseased arteries (P <0.01), ejection fraction (P <0.05), operation time (P <0.01), blood transfusion in ICU (P <0.05), and drainage in the first 12 hr (P <0.05).
Conclusions: Early tracheal extubation can be successfully performed in most patients receiving on-pump CABG. The management of higher-risk patients and efforts to reduce operation time and blood loss are keys to success for early tracheal extubation. (Ann Thorac Cardiovasc Surg 2009; 15: 239-242)

Key words: fast-track recovery, early tracheal extubation, on-pump coronary artery bypass grafting

Divisions of 1Cardiovascular Surgery and 2Anesthesiology, Nagasaki Kouseikai Hospital, Nagasaki, Japan

Received May 26, 2008; accepted for publication August 5, 2008
Address reprint requests to Manabu Sato, MD: Division of Cardiovascular Surgery, Nagasaki Kouseikai Hospital, 1–3–12 Hayama, Nagasaki 852–8053, Japan.