Impact of Immediate Versus Delayed Tracheal Extubation on Length of ICU Stay of Cardiac Surgical Patients
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 52
- 主要终点
- length of ICU stay
研究概览
简要总结
Ultra-fast track anaesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. This study compares the effect of UFTA versus continued postoperative mechanical ventilation on the ICU length of stay (LOS).
Methods. Fifty two elective adult patients were randomly allocated into UFTA and conventional groups by computer-generated random numbers. Redo operations, pre-operative intubation, uncontrolled diabetes, shock/LVEF <45%, PASP >55mmHg, creatinine clearance <50 ml min-1, haemodynamic instability, or those with concerns of postoperative bleeding were excluded. Pre- and intra-operative management was similar and Logistic EuroSCORE II was calculated for all. Intra-operatively, haemodynamic parameters, urine output, SPO2, arterial blood gas analysis (ABG), 5-lead ECG, operative- bypass- and cross clamp time, and opioid consumption were collected.
Postoperatively, patients were compared during their ICU stay. Data were analysed by χ²/Fischer exact, unpaired student's t-test, univariate two-group repeated measures ANOVA with post hoc Dunnett's test, and Mann-Whitney U tests as appropriate. p<0.05 was considered significant.
详细描述
Background The question whether early extubation leads to shorter post-operative length of ICU stay has rapidly gained importance over the past few decades considering the correlation between length of hospital stay and costs. Although some investigations did not find a difference between post-operative length of stay in early and late extubated patients, most observational studies and small randomized clinical trials showed significant benefits for early extubation.
Ultra-fast track anesthesia (UFTA) aims at immediate extubation of cardiac surgical patients at the end of the operation. There are few contraindications to the adoption of early extubation protocols. Generally most cardiac surgical patients, presenting for either elective or emergent surgery, have adequate ventilatory function. If patients were not intubated and ventilated preoperatively, they are not likely to require prolonged mechanical ventilation.
Goals of the study:
The primary goal of this study was to assess the impact of adopting UFTA on the length of ICU stay of patients undergoing elective cardiac surgery. The incidence of complications during their ICU stay was recorded as secondary outcome.
Methods From February, 2011, through October, 2013, 52 consecutive patients underwent open heart surgeries and were managed by the same anesthesiologists. Adult patients (>18yrs) scheduled for primary elective cardiac operations were included in the study.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Supportive Care
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 接受健康志愿者
- 否
入选标准
- •Adult elective cardiac surgery
排除标准
- •Redo operations,
- •pre-operative intubation,
- •uncontrolled diabetes,
- •shock/LVEF <45%,
- •PASP >55mmHg,
- •creatinine clearance <50 ml min-1,
- •haemodynamic instability,
- •concerns of postoperative bleeding
研究组 & 干预措施
Ultra Fast-Track Anesthesia
Patients who fulfilled the extubation criteria were extubated at the end of surgery and transferred to the ICU for follow up.
干预措施: Ultra Fast-Track Anesthesia (Procedure)
Conventional
patients who did not fulfill extubation criteria were left intubated and sedated and transferred to the ICU for later management
干预措施: Ultra Fast-Track Anesthesia (Procedure)
结局指标
主要结局
length of ICU stay
时间窗: post operative ICU stay (average 1 week)
We measured the length of ICU stay between the two groups
次要结局
未报告次要终点
研究者
Hisham Hosny
Assistant (associate) professor
Cairo University