Revisión sistemática con metaanálisis de estudios no aleatorizados sobre extubación orotraqueal inmediata en los procedimientos quirúrgicos cardíacos
Palabras clave:
tracheal extubation, enhanced recovery after surgery, immediate extubation, non-randomized studiesResumen
Introducción: Los resultados de las investigaciones que se han publicado son controversiales, Sin embargo, algunos autores coinciden en que la técnica es segura.
Objetivo: Estimar la efectividad de la implementación del protocolo en la evolución perioperatoria de pacientes programados para cirugía cardíaca.
Métodos: Se realizó una revisión sistemática con metaanálisis de estudios no aleatorizados, según las recomendaciones del manual 6.2.0 de la biblioteca Cochrane.
Resultados: Se incluyeron 26 artículos con un total de 688 227 pacientes (grupo experimental = 46 657; grupo control = 641570). La calidad metodológica en el 35 % fue clasificada como moderado y bajo riesgo de sesgo. El protocolo estuvo asociado a una disminución de: la reintubación orotraqueal posoperatoria (RR = 0,66 [0,32, 1,38] IC 95 %), de la readmisión (RR = 0,75 [0,49; 1,13] IC 95 %), de la estadía en Unidad de Cuidados Intensivos (DM = - 12,56 [ - 21,73, - 3,38] IC 95 % ) y la hospitalaria (DM = -1,42 [-1,84, - 0,99] IC 95 %); sin embargo, en relación con la incidencia de complicaciones, no se pudo demostrar la asociación, hasta que no se realizó el análisis de la sensibilidad, (previo, RR = 1,06 [1,02; 1,10] vs. posterior, RR = 0,73 [0,70; 0,76] IC del 95 %).
Conclusiones: La investigación aportó datos suficientes para tomar decisiones en relación con la implementación o no de la extubación inmediata en procedimientos quirúrgico cardíacos.
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