The benefits and new predictors of early extubation following coronary artery bypass grafting.

OBJECTIVE: This study researched cardiorespiratory effects and cost-effectiveness of early extubation in patients following coronary artery bypass grafting. METHODS: We retrospectively examined the character of 86 (38 preoperative, 12 intraoperative, 36 postoperative) variables in 78 patients after coronary artery bypass grafting (CABG) at our hospital. The patients were classified into three groups according to the time of extubation: Group A (less than 8 hours), Group B (8 to 24 hours) and Group C (24 hours or more). RESULTS: There were 43 patients in Group A (55%), 27 patients in Group B (35%), and 8 patients in Group C (10%). Univariate preoperative analysis revealed several differences between Groups A and B: 15 variables were found to reach statistical significance. Stepwise logistic regression analysis implicated decreased forced expiratory volume rate in the first second (FEV1.0%), postoperative cardiac index (CI) after admission to the intensive care unit (ICU) and usage of postoperative temporary pace-makers as predictors of late extubation. Also, there was a statistical significance in usage of diuretics within the first day (15.8+/-11.6 vs 28.8+/-22.6 mg; p = 0.044) and in the ICU days (3.6+/-0.8 vs 4.2+/-1.0; p = 0.004) between early and late extubation groups. CONCLUSIONS: Early extubation within 8 hours into the ICU stay was accomplished in 55% of the patients in this study. We speculate that the benefits of early extubation contain improvement of cardiac function, reduction in respiratory infection and complications, and cost saving as the result of diminished ICU admission. Also, we have shown that decreased FEV1.0%, decreased CI and the usage of a postoperative temporary pacemaker were independent predictors of prolonged intubation in our study.