Patient selection: extubation following CABG surgery
Reasons for reintubation include:
(1) pulmonary edema due to congestive heart failure
(2) hypoxemia due to lung disease
(3) carbon dioxide accumulation
(4) acute respiratory tract obstruction (mucus plug, other)
(5) "anesthetic metabolic insufficiency"
Risk factors for reintubation:
(1) preoperative chronic obstructive pulmonary disease (COPD)
(2) preoperative congestive heart failure (CHF)
(3) postoperative relative hypoxemia (last PaO2 prior to extubation between 70-90 mm Hg)
(4) postoperative acute kidney injury (AKI), defined as an absolute increase in serum creatinine > 0.3 mg/dL after surgery or relative increase > 50% compared to preoperative value
(5) postoperative total mechanical ventilation time in days (patients not requiring reintubation had durations of 1.1 to 2.1 days, while those requiring reintubation had durations of 1.7 to 8.7 days)
where:
• Most patients with CHF would have evidence preoperatively but some could have onset following surgery.
• A postoperative total mechanical ventilation time > 48 hours will be used in the implementation.
• The odds ratios (OR) for the risk factors range from 2 to 3.
