Systematic Review with Meta-analysis of Non-randomized Studies on Immediate Orotracheal Extubation in Cardiac Surgical Procedures
Keywords:
tracheal extubation, enhanced recovery after surgery, immediate extubation, non-randomized studiesAbstract
Introduction: Published research findings are controversial regarding the routine implementation of immediate extubation in cardiovascular surgical procedures. However, some authors agree that the technique is safe.
Objective: To estimate the effectiveness of implementing the protocol on the perioperative outcomes of patients scheduled for cardiac surgery.
Methods: A systematic review with meta-analysis of non-randomized studies was conducted, following the recommendations of Cochrane Library Manual 6.2.0. The outcomes assessed were orotracheal reintubation, length of stay and readmission to the Intensive Care Unit, postoperative complications, and length of hospital stay.
Results: Twenty-six articles were included, involving a total of 688,227 patients (experimental group = 46,657; control group = 641,570). The methodological quality of 35% of the studies was classified as having moderate or low risk of bias. The protocol was associated with a reduction in: postoperative orotracheal reintubation (RR = 0.66 [0.32, 1.38] 95 % CI), readmission (RR = 0.75 [0.49, 1.13] 95 % CI), length of stay in the Intensive Care Unit (MD = -12.56 [-21.73, -3.38] 95 % CI), and hospital length of stay (MD = -1.42 [- 1.84, - 0.99] 95 % CI); however, regarding the incidence of complications, no association could be demonstrated until the sensitivity analysis was performed (pre-extubation, RR = 1.06 [1.02; 1.10] vs. post-extubation, RR = 0.73 [0.70; 0.76], 95 % CI).
Conclusions: The study provided sufficient data to inform decisions regarding whether or not to implement immediate extubation in cardiac surgical procedures.
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