Proceedings from the Canadian Society of Respiratory Therapists Annual Conference May 11-13, 2023.

Abstract

Background: Early Extubation (EE), within 8 h of cardiac surgery, is associated with improved resource utilization. Studies demonstrate that for patients receiving fast track low-dose opioid cardiac anesthesia (FTCA) protocols EE is as safe as conventional care. Defining the earliest time points for safe extubation may be further beneficial. This review seeks to determine if immediate extubation (IE, in the operating room), is as safe as EE. For some individuals receiving FTCA protocols extubation is delayed. Understanding factors associated with delayed extubation is important to perioperative planning and resource management. This review seeks to identify factors associated with delayed extubation. Methods: MEDLINE, Cochrane Library, EMBASE and CINAHL (to March 2022) were searched. Studies pertaining to FTCA and IE, EE, or factors associated with delayed extubation were included. All authors extracted, appraised, and synthesized data. The main outcome measures were treatment outcomes and factors associated with delayed extubation. Results: Six studies investigated treatment outcomes associated with FTCA and IE. One RCT reported that outcomes associated with IE were comparable to those of EE. Five observational studies reported incidence for 16 treatment outcomes associated with IE but did not make comparisons to conventional care. Six observational studies assessed pre-and intraoperative factors associated with delayed extubation in FTCA patients. Thirty-seven factors were investigated and 22 were identified in at least one study. The most frequently reported factors were pre-existing cardiac insufficiency or renal disease, time on pump and cross-clamp time. Obesity and stroke were investigated but were not associated with delayed extubation. No study examined the influence of race, ethnicity or sex on outcomes. Discussion and Conclusions: Evidence pertaining to treatment outcomes associated with FTCA and IE is weak. Observational studies cannot