Document Detail


Early extubation versus prophylactic ventilation in the high risk patient: a comparison of postoperative management in the prevention of respiratory complications.
MedLine Citation:
PMID:  7053123     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
To evaluate whether prophylactic ventilation during the early postoperative period diminishes pulmonary complications, 35 high risk, elderly patients undergoing major, elective abdominal aortic reconstruction were prospectively randomized into either an early extubation group or a prophylactic ventilation group. The 17 patients assigned to the prophylactic ventilation group received mechanical ventilation by assist/control mode until 8 a.m. of the first postoperative day. The 17 patients assigned to the early extubation group were extubated after the operation as soon as they could maintain a pH of 7.35, with a spontaneous respiratory rate of less than 30. Preoperative measurements of functional residual capacity, intrapulmonary shunt, and oxygen delivery were compared to similar measurements during the initial two postoperative days. There were no significant differences between the groups with respect to age, length of operation, duration of anesthesia, operative blood loss, intraoperative fluid administration, or number of intraoperative transfusions. Patients in the prophylactic ventilation group were ventilated for an average of 18.3 +/- 0.5 hours. Patients in the early extubation group were ventilated for an average of 3.3 +/- 0.5 hours (p < 0.0005). No patient in either group required reintubation. Intrapulmonary shunt and oxygen delivery were not significantly different between the groups at any time during the study period. There was no mortality or significant morbidity in either group. These findings suggest that in high risk surgical patients, prophylactic ventilation, per se, may not diminish respiratory complications or improve gas exchange.
Authors:
S R Shackford; R W Virgilio; R M Peters
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  60     ISSN:  0003-2999     ISO Abbreviation:  Anesth. Analg.     Publication Date:  1981 Feb 
Date Detail:
Created Date:  1981-04-13     Completed Date:  1981-04-13     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  76-80     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Functional Residual Capacity
Hemodynamics
Humans
Intubation, Intratracheal*
Male
Middle Aged
Postoperative Care / methods
Postoperative Complications / prevention & control*
Random Allocation
Respiration, Artificial*
Respiratory Tract Diseases / prevention & control*
Time Factors
Grant Support
ID/Acronym/Agency:
GM 17284/GM/NIGMS NIH HHS; HL 13172/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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