Volume 74, Issue 9 (December 2016)                   Tehran Univ Med J 2016, 74(9): 657-663 | Back to browse issues page

XML Persian Abstract Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Barkhordari K, Yaghooti S, Nikkhah S, Aein A, Jalali A, Shafiee A. Clinical outcome of tracheal extubatedcardiac surgery patients who did not meet protocol driven laboratory criteria for extubation. Tehran Univ Med J. 2016; 74 (9) :657-663
URL: http://tumj.tums.ac.ir/article-1-7809-en.html
1- Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. , kh.barkhordari@gmail.com
2- Department of Internal Medicine, Shariati Hospital, Tehran Univer-sity of Medical Sciences, Tehran, Iran.
3- Food and Drug Bureau, Ministry of Health and Medical Education, Tehran, Iran.
4- Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
5- Department of Anesthesiology and Critical Care, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran. Department of Community Med-icine, School of Medicine, Sha-hid Beheshti University of Medi-cal Sciences, Tehran, Iran.
Abstract:   (2702 Views)

Background: We retrospectively compared the clinical outcome of post-cardiac surgery tracheal extubation between patients extubated with a lower than normal pH and patients extubated according to our routine institutional protocol. Our main goal was to clarify that strict adherence to the current criteria is dispensable.

Methods: In this retrospective cohort study, we recruited 256 patients who met our study criteria and divided them into the exposed group (n= 95) and the control group (n= 161). The inclusion criteria consisted of coronary artery bypass grafting alone and age> 18 years. The exclusion criteria comprised the use of corticosteroids in the preceding 2 weeks, Serum creatinine (SCr)> 2 mg/dL, uncontrolled diabetes, liver dysfunction, Glasgow coma scale <13, and acetazolamide and sodium bicarbonate use. The arterial blood gas (ABG) characteristics before and 6 hours after extubation, extubation failure rate, length of stay in the in ICU, length of stay in the hospital and mortality were compared between the two groups.

Results: In the control group, the males outnumbered the females and the ejection fraction was higher relative to that in the exposure group (P= 0.01 and P= 0.02, respectively). There were more patients with chronic obstructive pulmonary disease in the exposure group (P< 0.005) and also the euroSCORE was higher (P< 0.002). There were no significant differences between the groups regarding the ABG values at the time of ICU admission. Significantly higher levels of FiO2 and PaCO2 (P< 0.001 for both) as well as lower HCO3 and pH (P< 0.001 for both) were observed in the exposure group immediately before extubation. Following extubation, there was a significant increase in pH and a significant reduction in FiO2 need in the exposure group (P< 0.001 for both). The extubation failure rate, length of stay in the in ICU, length of stay in the hospital, and mortality rate were not different between the 2 groups.

Conclusion: The patients with a lower than normal pH, tracheal extubated at the discretion of the ICU anesthesiologist did not have a clinical outcome worse than that of the patients extubated in accordance with our routine institutional protocol.

Full-Text [PDF 296 kb]   (719 Downloads)    
Type of Study: Original Article |

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


© 2019 All Rights Reserved | Tehran University Medical Journal TUMS Publications

Designed & Developed by : Yektaweb