Early Tracheal Extubation after Coronary Artery Bypass Graft Surgery Reduces Costs and Improves Resource Use

1996 ◽  
Vol 85 (6) ◽  
pp. 1300-1310. ◽  
Author(s):  
Davy C. H. Cheng ◽  
Jacek Karski ◽  
Charles Peniston ◽  
Ganesh Raveendran ◽  
Buvanendran Asokumar ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Resource Use ◽  
Anesthetic Management ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Cost Savings ◽  
Tracheal Extubation ◽  
Early Extubation ◽  
Total Cost ◽  
Cabg Surgery

Background Economics has caused the trend of early tracheal extubation after cardiac surgery, yet no prospective randomized study has directly validated that early tracheal extubation anesthetic management decreases costs when compared with late extubation after cardiac surgery. Methods This prospective, randomized, controlled clinical trial was designed to evaluate the cost savings of early (1-6 h) versus late tracheal extubation (12-22 h) in patients after coronary artery bypass graft (CABG) surgery. The total cost for the services provided for each patient was determined for both the early and late groups from hospital admission to discharge home. All costs applicable to each of the services were classified into direct variables, direct fixed costs, and overhead (an indirect cost). Physician fees and heart catheterization costs were included. The total service cost was the sum of unit workload and overhead costs. Results One hundred patients having elective CABG who were younger than 75 yr were studied. Including all complications, early extubation (n = 50) significantly reduced cardiovascular intensive care unit (CVICU) costs by 53% (P < 0.026) and the total CABG surgery cost by 25% (P < 0.019) when compared with late extubation (n = 50). Forty-one patients (82%) in each group were tracheally extubated within the defined period. In the early extubation group, the actual departmental cost savings in CVICU nursing and supplies was 23% (P < 0.005), in ward nursing and supplies was 11% (P < 0.05), and in respiratory therapy was 12% (P < 0.05). The total cost savings per patient having CABG was 9% (P < 0.001). Further cost savings using discharge criteria were 51% for CVICU nursing and supplies (P < 0.001), 9% for ward nursing and supplies (P < 0.05), and 29% for respiratory therapy (P < 0.001), for a total cost savings per patient of 13% (P < 0.001). Early extubation also reduced elective case cancellations (P < 0.002) without any increase in the number of postoperative complications and readmissions. Conclusions Early tracheal extubation anesthetic management reduces total costs per CABG surgery by 25%, predominantly in nursing and in CVICU costs. Early extubation reduces CVICU and hospital length of stay but does not increase the rate or costs of complications when compared with patients in the late extubation group. It shifts the high CVICU costs to the lower ward costs. Early extubation also improves resource use after cardiac surgery when compared with late extubation.

Ongoing Variability in Transfusion Practices in Cardiac Surgery Despite Established Guidelines.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 947-947 ◽  
Author(s):  
Stephanie A. Snyder-Ramos ◽  
Patrick Moehnle ◽  
Yi-Shin Weng ◽  
Bernd W. Boettiger ◽  
Alexander Kulier ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Evaluation System ◽  
Blood Product ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Fresh Frozen Plasma ◽  
Transfusion Practice ◽  
Cabg Surgery ◽  
Fresh Frozen ◽  
Frozen Plasma

Abstract Although blood utilization has been under considerable scrutiny for the past two decades, particularly for surgery, the international evolution of standards remains unknown. Therefore, the objective of this study was to compare the perioperative transfusion of blood components in patients undergoing coronary artery bypass graft (CABG) surgery in different countries. Transfusion practice was investigated prospectively among 16 countries (70 centers). Five-thousand sixty-five (5,065) randomly selected cardiac surgery patients in the Multicenter Study of Perioperative Ischemia Epidemiology II (EPI II) Study were evaluated. Utilization of red blood cells, fresh frozen plasma, and platelets was assessed by day, prior to, during and after surgery until hospital discharge. Intraoperative red blood cell (RBC) transfusion varied from 9 percent to 100 percent among the 16 countries, and 25 percent to 87 percent postoperatively (percent of transfused patients). Similarly, transfusion of fresh frozen plasma (FFP) varied from 0 percent to 98 percent intraoperatively and 3 percent to 95 percent postoperatively, and platelet (PL) transfusion from 0 percent to 51 percent and 0 percent to 39 percent, respectively. An analysis of the EuroSCORE (an internationally validated risk evaluation system for cardiac surgery) risk indices of the countries with the highest and lowest frequencies of use or amounts of each of type blood product failed to demonstrate a correlation between EuroSCOREs and maximum vs minimum frequency of use or amount of blood product administered. Establishment of international guidelines for utilization of blood products in CABG surgery appears necessary.

Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients

2016 ◽  
Vol 9 (2) ◽  
pp. 236-248
Author(s):  
Alicia Williams ◽  
Lyn Stankiewicz Murphy
Keyword(s):  
Cardiac Surgery ◽  
Content Validity ◽  
Patient Population ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Interrater Agreement ◽  
Early Extubation ◽  
Artery Bypass Graft ◽  
Validity Index ◽  
Item Content

Introduction:Patients undergoing coronary artery bypass graft surgery will require intubation and the use of mechanical ventilation during and after surgery. It is well accepted that early extubation is associated with not only positive patient outcomes but also organizational outcomes as well. Patients who are not extubated early are at risk for complications associated with prolonged intubation. The literature supports the use of protocol aid with early extubation. The goal and expected outcome of this project is to establish the usability of an early extubation protocol by assessing its appropriateness for use in the postoperative cardiac surgical adult patient.Methods:For the purpose of establishing content validity of an early extubation protocol, 2 protocols were chosen from the literature. Fifteen cardiac surgery experts were invited to select the protocol they felt was most appropriate for use in this patient population. These reviewers were then asked to further analyze the protocol based on a 5-question survey. Their response was used to calculate a scale-content validity index (S-CVI) and an item-content validity index (I-CVI).Results:Twelve of 15 experts participated in the project. The content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI) and (b) S-CVI. The means were established for each item. Content validity was estimated using (a) interrater agreement for relevance for each item (I-CVI: 0.75–1.00); and the S-CVI/average = 0.92. Cronbach’s alpha was estimated to establish reliability (0.972).Conclusion:Selecting an appropriate protocol to be used in this patient population is the first step in implementing an effective early extubation process. The results highly suggest that the content of this protocol is quite relevant in this patient population. It is hoped that this will set the stage for early extubation in postoperative cardiac surgery patients.

scholarly journals Study on the Effect of Total Intravenous Anesthesia (TIVA) on the Post-operative Respiratory Performance Regarding Early Extubation after Coronary Artery Bypass Graft (CABG) Surgery

1970 ◽  
Vol 29 (1) ◽  
pp. 3-9
Author(s):  
AKMF Hoque ◽  
Z Rahman ◽  
AH Habib ◽  
A Ali ◽  
A Islam ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Prolonged Mechanical Ventilation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Extubation ◽  
Artery Bypass Graft ◽  
Cabg Surgery

The outcome of anaesthesia in coronary artery surgery depends partly on the duration of invasive manipulations including endotracheal intubation. It is ideal to avoid prolonged mechanical ventilation and attempt early extubation. Depressant effect of some anaesthetic agents and narcotics makes it a common practice to ventilate the patients of coronary artery bypass graft (CABG) surgery overnight resulting in unsatisfactory respiratory and haemodynamic performance. This study was aimed at overcoming the effects of prolonged mechanical ventilation after CABG surgery by using Total Intravenous Anaesthesia (TIVA) and by extubating the patient early to achieve a better postoperative respiratory cardiovascular performance. The study was conducted prospectively on 40 patients between 40 to 60 years, divided into two groups of 20 patients each. Gr.-A received infusions of Propofol 2-6 mg/kg/hr, Fentanyl 0.5-1.25 mg/kg/hr and Pancuronium bromide 0.01mg/kg. Postoperatively Propofol was continued in infusion for one hour while Inj. Diclofenac sodium was used as an analgesic. Patients in group B received a typical conventional anaesthesia and were ventilated electively till next morning. The study showed that in CABG surgery, TIVA produces non-significant depression of post-operative respiratory performance which helps in early extubation compared to those receiving conventional anaesthesia and electively ventilated overnight. Key words: TIVA; CABG; Early extubation DOI: 10.3329/jbsp.v29i1.7164J Bangladesh Coll Phys Surg 2011; 29:3-9

scholarly journals Effect of sevoflurane on the inflammatory response during cardiopulmonary bypass in cardiac surgery: the study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Thiago Augusto Azevedo Maranhão Cardoso ◽  
Gudrun Kunst ◽  
Caetano Nigro Neto ◽  
José de Ribamar Costa Júnior ◽  
Carlos Gustavo Santos Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Inflammatory Response ◽  
Controlled Trial ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Volatile Anesthetic ◽  
Serum Levels ◽  
Randomized Controlled

Abstract Background Recent experimental evidence shows that sevoflurane can reduce the inflammatory response during cardiac surgery with cardiopulmonary bypass. However, this observation so far has not been assessed in an adequately powered randomized controlled trial. Methods We plan to include one hundred patients undergoing elective coronary artery bypass graft with cardiopulmonary bypass who will be randomized to receive either volatile anesthetics during cardiopulmonary bypass or total intravenous anesthesia. The primary endpoint of the study is to assess the inflammatory response during cardiopulmonary bypass by measuring PMN-elastase serum levels. Secondary endpoints include serum levels of other pro-inflammatory markers (IL-1β, IL-6, IL-8, TNFα), anti-inflammatory cytokines (TGFβ and IL-10), and microRNA expression in peripheral blood to achieve possible epigenetic mechanisms in this process. In addition clinical endpoints such as presence of major complications in the postoperative period and length of hospital and intensive care unit stay will be assessed. Discussion The trial may determine whether adding volatile anesthetic during cardiopulmonary bypass will attenuate the inflammatory response. Trial registration ClinicalTrials.gov NCT02672345. Registered on February 2016 and updated on June 2020.

scholarly journals Acute Onset Ocular Hypotony after Coronary Artery Bypass Surgery

2017 ◽  
Vol 8 (1) ◽  
pp. 200-207
Author(s):  
Sarah Farukhi Ahmed ◽  
Audrey Xi Tai ◽  
Mason Schmutz ◽  
John Combs ◽  
Sameh Mosaed
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Vision Loss ◽  
Artery Bypass ◽  
Venous Pressure ◽  
Bypass Graft ◽  
Ischemic Optic Neuropathy ◽  
Cabg Surgery ◽  
Ocular Hypotony

Importance: The purpose of this case report is to evaluate risk factors associated with post-coronary artery bypass graft (CABG) ocular hypotony compared to post-CABG ischemic optic neuropathy. Observations: The patient described here is a single case at the University of California, Irvine Medical Center, from July 2016. This case demonstrates the rare incidence of acute post-CABG ocular hypotony and vision loss in a patient with prior history of optic atrophy. Both vision loss and hypotony resolved completely to baseline without intervention within 3 days postoperatively. Conclusions and Relevance: Severe anemia and large fluctuations in central venous pressure and blood pressure can occur in any patient undergoing CABG surgery. These hemodynamic shifts can cause transient ischemia to pressure controlling systems such as the ciliary body and reduce episcleral venous pressure. Other risk factors for acute hypotony in the setting of CABG surgery also include the use of hypertonic agents, cardiopulmonary bypass, and intravenous anesthesia.

IMMUNE FUNCTION IN THE EARLY POSTOPERATIVE PERIOD PREDICTS OUTCOME IN CORONARY ARTERY BYPASS GRAFT (CABG) SURGERY

1990 ◽  
Vol 18 (Supplement) ◽  
pp. S252
Author(s):  
Marcus P. Haw ◽  
Gregory T. Steltzer ◽  
Emma J. Lewis ◽  
Bradley C. Borlase ◽  
Lynda Kabbash ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Graft ◽  
Immune Function ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Early Postoperative Period ◽  
Artery Bypass Graft ◽  
Cabg Surgery

Pharmacokinetics of Propofol in Adult Patients Undergoing Coronary Revascularization

1996 ◽  
Vol 84 (6) ◽  
pp. 1288-1297 ◽  
Author(s):  
James M. Bailey ◽  
Christina T. Mora ◽  
Stephen L. Shafer ◽  
Keyword(s):  
Cardiac Surgery ◽  
Cross Validation ◽  
Predictive Accuracy ◽  
Coronary Revascularization ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Adult Patients ◽  
Pharmacokinetic Parameters ◽  
Surgery Patient ◽  
Prospective Comparison

Background Propofol is increasingly used for cardiac anesthesia and for perioperative sedation. Because pharmacokinetic parameters vary among distinct patient populations, rational drug dosing in the cardiac surgery patient is dependent on characterization of the drug's pharmacokinetic parameters in patients actually undergoing cardiac procedures and cardiopulmonary bypass (CPB). In this study, the pharmacokinetics of propofol was characterized in adult patients undergoing coronary revascularization. Methods Anesthesia was induced and maintained by computer-controlled infusions of propofol and alfentanil, or sufentanil, in 41 adult patients undergoing coronary artery bypass graft surgery. Blood samples for determination of plasma propofol concentrations were collected during the predefined study periods and assayed by high-pressure liquid chromatography. Three-compartment model pharmacokinetic parameters were determined by nonlinear extended least-squares regression of pooled data from patients receiving propofol throughout the perioperative period. The effect of CPB on propofol pharmacokinetics was modeled by allowing the parameters to change with the institution and completion of extracorporeal circulation and selecting the optimal model on the basis of the logarithm of the likelihood. Predicted propofol concentrations were calculated by convolving the infusion rates with unit disposition functions using the estimated parameters. The predictive accuracy of the parameters was evaluated by cross-validation and by a prospective comparison of predicted and measured levels in a subset of patients. Results Optimal pharmacokinetic parameters were: central compartment volume = 6.0 l; second compartment volume = 49.5 l; third compartment volume = 429.3 l; Cl1 (elimination clearance) = 0.68 l/min; Cl2 (distribution clearance) = 1.97 l/min1; and Cl3 (distribution clearance) = 0.70 l/min. The effects of CPB were optimally modeled by step changes in V1 and Cl1 to values of 15.9 and 1.95, respectively, with the institution of CPB. Median absolute prediction error was 18% in the cross-validation assessment and 19% in the prospective evaluation. There was no evidence for nonlinear kinetics. Previously published propofol pharmacokinetic parameter sets poorly predicted the observed concentrations in cardiac surgical patients. Conclusions The pharmacokinetics of propofol in adult patients undergoing cardiac surgery with CPB are dissimilar from those reported for other adult patient populations. The effect of CPB was best modeled by an increase in V1 and Cl1. Predictive accuracy of the derived pharmacokinetic parameters was excellent as measured by cross-validation and a prospective test.

Sign in / Sign up

Export Citation Format

Share Document