HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gall, S. A. Articles by Rankin, J. S. Search for Related Content PubMed PubMed Citation Articles by Gall, S. A., Jr Articles by Rankin, J. S.

The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 819-827, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Beneficial effects of endotracheal extubation on ventricular performance. Implications for early extubation after cardiac operations

SA Gall Jr, CO Olsen, JG Reves, RW McIntyre, GS Tyson Jr, JW Davis and JS Rankin
Department of Surgery, Duke University Medical Center, Durham, NC 27710.

Early endotracheal extubation has been shown to be a safe postoperative management option in patients having cardiac operations. However, few objective data exist on the response of ventricular performance to early termination of controlled ventilation. Seven patients undergoing routine elective coronary artery bypass grafting or adult repair of atrial septal defect were studied after intraoperative placement of left ventricular micromanometers, left ventricular minor axis dimension crystals, and left atrial and intrapleural pressure catheters. Physiologic data were recorded intraoperatively, during controlled mandatory ventilation in the intensive care unit, and during spontaneous respiration immediately after extubation. Extubation to spontaneous breathing was associated with a significant decline in intrapleural pressure and significant increases in left ventricular end- diastolic diameter, ejection diameter shortening, stroke work, and cardiac output. The augmented left ventricular diastolic filling seemed to result from the fall in intrapleural pressure and perhaps from normalization of right ventricular afterload. The preload recruitable stroke work relationship showed that myocardial contractility remained constant after extubation, and ventricular function improved primarily because of increased preload associated with shifting of the capacitance blood volume toward the chest. Thus endotracheal extubation enhances cardiac performance after uncomplicated cardiac surgical procedures, and by this mechanism early extubation may be clinically beneficial as a routine adjunct to postoperative care.

This article has been cited by other articles:

				N. Charokopos, P. Antonitsis, M. Toumbouras, J. Konstantinopoulos, and E. Rouska Influence of Fast-Track Recovery after Coronary Artery Bypass in the Elderly Asian Cardiovasc Thorac Ann, April 1, 2007; 15(2): 144 - 148. [Abstract] [Full Text] [PDF]

				C. Alhan, F. Toraman, E. H. Karabulut, S. Tarcan, S. Dagdelen, N. Eren, and N. Caglar Fast track recovery of high risk coronary bypass surgery patients Eur. J. Cardiothorac. Surg., May 1, 2003; 23(5): 678 - 683. [Abstract] [Full Text] [PDF]

				R. Salenger, J. S. Gammie, and T. J. Vander Salm Postoperative Care of Cardiac Surgical Patients Card. Surg. Adult, January 1, 2003; 2(2003): 439 - 469. [Full Text]

				J.F. Legare, G.M. Hirsch, K.J. Buth, C. MacDougall, and J.A. Sullivan Preoperative prediction of prolonged mechanical ventilation following coronary artery bypass grafting Eur. J. Cardiothorac. Surg., November 1, 2001; 20(5): 930 - 936. [Abstract] [Full Text] [PDF]

				L. G. Michelsen, N. H. G. Holford, W. Lu, J. F. Hoke, C. C. Hug, and J. M. Bailey The Pharmacokinetics of Remifentanil in Patients Undergoing Coronary Artery Bypass Grafting with Cardiopulmonary Bypass Anesth. Analg., November 1, 2001; 93(5): 1100 - 1105. [Abstract] [Full Text] [PDF]

				E. Zarate, P. Latham, P. F. White, R. Bossard, L. Morse, L. K. Douning, C. Shi, and L. Chi Fast-Track Cardiac Anesthesia: Use of Remifentanil Combined with Intrathecal Morphine as an Alternative to Sufentanil During Desflurane Anesthesia Anesth. Analg., August 1, 2000; 91(2): 283 - 287. [Abstract] [Full Text] [PDF]

				A. K. Konstantakos and J. H. Lee Optimizing timing of early extubation in coronary artery bypass surgery patients Ann. Thorac. Surg., June 1, 2000; 69(6): 1842 - 1845. [Abstract] [Full Text] [PDF]

				J. H. Lee, B. Swain, J. Andrey, H. K. Murrell, and A. S. Geha Fast track recovery of elderly coronary bypass surgery patients Ann. Thorac. Surg., August 1, 1999; 68(2): 437 - 441. [Abstract] [Full Text] [PDF]

				C. A. Sirio and G. D. Martich Who Goes to the ICU Postoperatively? Chest, May 1, 1999; 115(suppl_2): 125S - 129S. [Abstract] [Full Text] [PDF]

				R. Juca and L. Monte Early tracheal extubation after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., October 1, 1997; 114(4): 687 - 687. [Full Text]

				J. S. Heinle, L. K. Diaz, and L. S. Fox EARLY EXTUBATION AFTER CARDIAC OPERATIONS IN NEONATES AND YOUNG INFANTS J. Thorac. Cardiovasc. Surg., September 1, 1997; 114(3): 413 - 418. [Abstract] [Full Text]

				K. Bando, K. Sun, R. S. Binford, and T. G. Sharp Determinants of Longer Duration of Endotracheal Intubation After Adult Cardiac Operations Ann. Thorac. Surg., April 1, 1997; 63(4): 1026 - 1033. [Abstract] [Full Text]

				R. H. Habib, A. Zacharias, and M. Engoren Determinants of Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting Ann. Thorac. Surg., October 1, 1996; 62(4): 1164 - 1171. [Abstract] [Full Text]

				K. V. Arom, R. W. Emery, R. J. Petersen, and M. Schwartz Cost-Effectiveness and Predictors of Early Extubation Ann. Thorac. Surg., July 1, 1995; 60(1): 127 - 132. [Abstract] [Full Text]