Is routine extubation overnight safe in cardiac surgery patients?
Aged
Airway Extubation
/ adverse effects
Cardiac Surgical Procedures
/ adverse effects
Databases, Factual
Female
Humans
Intubation, Intratracheal
/ adverse effects
Length of Stay
Male
Middle Aged
North Carolina
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Virginia
aortic valve replacement
coronary artery bypass grafting
extubation
mitral valve replacement
ventilation
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
05
02
2018
revised:
21
08
2018
accepted:
25
08
2018
pubmed:
24
12
2018
medline:
25
2
2020
entrez:
23
12
2018
Statut:
ppublish
Résumé
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database. Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00. A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality. Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight.
Identifiants
pubmed: 30578055
pii: S0022-5223(18)32926-X
doi: 10.1016/j.jtcvs.2018.08.125
pmc: PMC6431279
mid: NIHMS1517031
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
1533-1542.e2Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007849
Pays : United States
Organisme : NHLBI NIH HHS
ID : UM1 HL088925
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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