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Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients  Brigid C. Flynn, MD, Jianghua He, PhD, Matthew Richey, MD, Katy.

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Presentation on theme: "Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients  Brigid C. Flynn, MD, Jianghua He, PhD, Matthew Richey, MD, Katy."— Presentation transcript:

1 Early Extubation Without Increased Adverse Events in High-Risk Cardiac Surgical Patients 
Brigid C. Flynn, MD, Jianghua He, PhD, Matthew Richey, MD, Katy Wirtz, RN, Emmanuel Daon, MD  The Annals of Thoracic Surgery  Volume 107, Issue 2, Pages (February 2019) DOI: /j.athoracsur Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

2 Fig 1 Depiction of The Society of Thoracic Surgeons (STS) predicted prolonged ventilation score and the STS predicted morbidity or mortality scores. The two scores are highly correlated before (Pre) and after (Post) early extubation protocol initation. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

3 Fig 2 There was no significant difference in terms of The Society of Thoracic Surgeons (STS) predicted morbidity or mortality scores before (Pre) and after (Post) early extubation protocol implementation. (AEs = composite adverse events; Dth = death; RF= risk factor; Strk = stroke.) The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

4 Fig 3 Before implementation of the early extubation protocol (Pre), The Society of Thoracic Surgeons (STS) predicted morbidity or mortality scores positively correlated with log of ventilation (vent) hours (correlation coefficient r = , p < ), meaning higher risk individuals had longer ventilation times. After protocol change (Post), STS scores no longer correlated with log of ventilation times (r = , p = 0.97). The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

5 Fig 4 Stratification of patients based on The Society of Thoracic Surgeons (STS) predicted morbidity or mortality risk score into four groups demonstrated that the higher STS risk groups (group 3: STS 13.5% to 19.5%; group 4: STS 19.6% to 91%) had a larger and significant reduction in ventilation times from a median (1st quartile to 3rd quartile) of 9.2 (6.5 to 15.4) hours before the protocol (Pre) to 5.7 (4.5 to 9.8) hours after protocol initiation (Post) (p < ). In the lower-risk patients (group 1: STS 3.2% to 8.8%; group 2: STS 8.8% to 13%) ventilation times did not significantly differ from pre- to post-protocolization median (1st quartile to 3rd quartile) (pre-protocol 6.3 [5.12 to 9.42] hours to post-protocol 5.7 [4.3 to 8.7] hours; p = 0.13). The dashed line denotes a ventilation time of 6 hours. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

6 Fig 5 A subanalysis of the highest-risk patients (The Society of Thoracic Surgeons [STS] predicted morbidity or mortality score of more than 40%; n = 14; 8 before [pre] and 6 after [post] protocol) demonstrated that after the protocol, all had ventilation times shorter than 6 hours. The dashed line denotes a ventilation (vent) time of 6 hours. The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur ) Copyright © 2019 The Society of Thoracic Surgeons Terms and Conditions

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