Factors Affecting Extubation Time in Patients Undergoing Coronary Artery Bypass Grafting Surgery

OBJECTIVE: To study the factors affecting the Extubation time in patients undergoing Coronary Artery bypass grafting surgery. MATERIAL AND METHODS: After approval from the ethical committee, a retrospective observational study was conducted, and data on the patients undergoing coronary artery bypass grafting surgery was collected from 1 January to 30 September 2024. Adult patients undergoing CABG surgery patients who require postoperative mechanical ventilation were included while patients who underwent combined procedures CABG + valve replacement or any other Open Heart surgeries, Patients with pre existing mechanical ventilation & Patients who expired within 24 hrs of ICU admission were excluded from the study. Data collection was done using the hospital's EMR system which included pt's demographic characteristics, preoperative status like ejection fraction, lab investigations, etc, Intraoperative data like duration of surgery, blood loss, number of grafts used, MAP, inotropes used, use of pack cells, Postoperative data like no of inotropes used, use of IABP, drain volume, extubation time {early (< 6 hrs) vs late (> 6 hrs), any post-operative complications, length of stay in ICU and mortality data was collected. Patients were grouped based on extubation time: Early extubation < 6 hrs post-surgery Delayed extubation > 6 hrs post-surgery Statistical analysis -continuous variables were summarised as means ± SD, comparison between two groups was for continuous variables performed using Student's t-test or Mann Whitney test, and logistic regression analysis was used to identify predictors of early and late extubation. RESULTS: Among the 51 cases which we studied, the mean age was 61.16 ±10.8 years. Early extubation was achieved in 65.31% of patients (n=32) while 34.69% of patients (n=17) had delayed extubation. The median extubation time was 10.03 ± 13.15 hours. The extubation time was significantly affected by this factors Blood loss during surgery, duration of surgery, no of inotropes required & ejection fraction. Multivariate Logistic regression Analysis revealed that Blood loss during surgery was a significant independent risk factor for delayed extubation. With the increase in blood loss, the risk for delayed extubation significantly increases with adjusted Odds Ratio of 1.006. Early extubation was associated with lower mortality and fewer postoperative complications while Patients in the delayed group had a longer ICU stay and also higher rate of reintubation. DISCUSSION: The study demonstrates that early extubation after CABG is associated with improved outcomes including shorter ICU stays and reduced rate of complication rate, this findings align with prior research work emphasizing the benefits of fast-track protocols in cardiac surgery. Delayed extubation was linked to older age, higher BMI, and intraoperative complications consistent with existing studies. CONCLUSION: In patients undergoing CABG surgery, some perioperative & post-operative factors had significant effects. Therefore, considering this factors is important for designing a treatment plan & evaluating patients prognosis. This study highlights the importance of early extubation although a future large sample size study is required to validate these findings.