番茄社区

SAN DIEGO -- Extubation on the operating table after cardiac bypass is rare in the U.S., but researchers suggested here that it paid off in certain procedures by shrinking the average length of hospital stay.

In a retrospective single-center analysis, Jonathan L. Parmet, MD, of Society Hill Anesthesia Consultants in Philadelphia, and colleagues, compared patient experiences over several years after an effort to promote on-table extubation (OTE) was put into place at Pennsylvania Hospital in Philadelphia in 2015.

In 2012, no patient underwent OTE in isolated coronary bypass artery grafting (CABG) surgeries, and just 7% did in 2013, they said in a presentation at the Society of Thoracic Surgeons (STS) annual meeting.

From June 12, 2015 to Dec. 31, 2017, the OTE rate grew from 60% to 76%. The average length of stay for OTE patients, meanwhile, was 5.6 days versus 9.2 days for non-OTE patients.

"We're beginning to accelerate their post-operative recovery by getting the breathing tube out, and some patients go home 3 days after surgery. One patient went home in 2 days," Parmet told 番茄社区.

Parmet said OTE is uncommon in cardiac procedures in the U.S., despite research suggesting its value compared with extubation during the recovery process. He added that just 2.4% of CABG patients in 2017 underwent OTE, according to a national STS database.

Use of post-operative narcotics also went down, Parmet said, and some patients were even walking the night of surgery. "Rather than trying to meet the benchmark of extubating in the ICU in less than 6 hours, the nurses are working on getting the patient out of bed and ambulating, hence accelerating recovery," he explained.

Also, patients don't need to fear the extubation. "If you talk to patients who are coming in to have this procedure a second time, what they remember isn't the pain," he said. "It's having the breathing tube in after the operation. Despite the enormity of having your heart operated on, patients fear remaining intubated after the operation."

Cardiothoracic anesthesiologist Jessica Brodt, MBBS, of Stanford University Medical Center in California, told 番茄社区 that the findings jive with other studies that have shown benefits of earlier extubation. Centers may be more or less willing to embrace OTE depending on factors such as ICU support, surgical volume (a busier operating room may not allow time for extubation), and the personal preferences of attending surgeons and anesthesiologists, she noted.

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