The safety of immediate extubation, and factors associated with delayed extubation, in cardiac surgical patients receiving fast-track cardiac anesthesia: An integrative review
Notice bibliographique
Résumé
Background: Early extubation (EE), within 8 h of cardiac surgery, is associated with improved resource utilization. Studies have demonstrated that for patients receiving low-dose, fast-track opioid cardiac anesthesia (FTCA) protocols, EE is as safe as conventional care. To date, it is unclear when the earliest timepoints for safe extubation might be. Additionally, some authors pointed out that certain patients receiving FTCA protocols frequently experience delays during extubation attempts. Understanding the factors associated with delayed extubation is crucial for perioperative planning and resource management. This review seeks to 1) determine whether immediate extubation (IE) in the operating room is as safe as EE and 2) identify factors associated with delayed extubation. Methods: MEDLINE, Cochrane Library, EMBASE and CINAHL (up to March 2022) were searched. Studies pertaining to FTCA, IE, EE or factors associated with delayed extubation were included. All authors extracted, appraised and synthesized data. The primary outcome measures were treatment results and factors associated with delayed extubation. Results: Six studies investigated treatment outcomes associated with FTCA and IE. One randomized controlled trial reported that outcomes associated with IE were comparable to those with EE. Five observational studies reported incidence for 19 treatment outcomes associated with IE, but no comparisons were made to EE. Six observational studies assessed pre- and intraoperative factors associated with delayed extubation in FTCA patients. In at least one study, 37 factors were investigated and 22 were identified. The most frequently reported factors were pre-existing cardiac insufficiency or renal disease, time on pump and cross-clamp time. Obesity and stroke were investigated but were not associated with delayed extubation. No study examined the influence of race, ethnicity or gender on outcomes. Discussion and conclusion: Evidence pertaining to treatment outcomes associated with FTCA and IE is weak. Observational studies cannot determine causation. Large multicentre randomized control trials are required to determine the safety of IE. Although numerous factors have been associated with delayed extubation, several studies do not describe how or which factors were selected for examination. Therefore, certain factors may have yet to be evaluated. Future studies should comprehensively define all factors under investigation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,005 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».