Relationship Between Demographic Characteristics, Clinical Parameters, and Extubation Time in Post-Cardiac Surgery Patients

Document Type : Original Article


1 Nursing Care Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Nursing and Midwifery Faculty, Iran University of Medical Sciences, Tehran, IR Iran.

3 Echocardiography research center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

4 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.


Background: Understanding factors influencing extubation in cardiac surgery patients is essential. This study aimed to determine the relationship between demographic characteristics, medical and clinical variables, and the extubation time in patients undergoing cardiac surgery in a cardiovascular center.
Methods: This causal-comparative study was conducted on 210 adult patients who underwent cardiac surgery in 2018 in Tehran. The study samples were selected via the convenience sampling method. The data collection tool was a researcher-made observation checklist that featured 4 sections on the patients’ demographic characteristics, clinical variables during surgery, clinical conditions in the ICU, and high-risk factors related to the disease. The subjects were categorized into 2 study groups of more than 6 hours of mechanical ventilation and equal to or less than 6 hours of mechanical ventilation based on their mechanical ventilation time. Via the multivariate analysis test, the factors affecting endotracheal tube extubation were determined. IBM SPSS Statistics software, version 21, was used for statistical analysis.
Results: The study population consisted of 210 post-cardiac surgery patients, 142 men and 68 women, at a median age of 55 years. The findings indicated that age, sedation, and the duration of pulmonary circulation had a significant influence on the extubation time in post-cardiac surgery patients.
Conclusions: In our sample of post-cardiac surgery patients, age, sedation, and the duration of pulmonary circulation impacted the process of extubation. The implementation of a precise discontinuation program from mechanical ventilation by considering these factors is recommended to prevent long-term mechanical ventilation and shorten the ICU length of stay. (Iranian Heart Journal 2022; 23(1): 140-148)


  1. AMULA, V., VENER, D. F., PRIBBLE, C. G., RIEGGER, L., WILSON, E. C., SHEKERDEMIAN, L. S., OU, Z., PRESSON, A. P., WITTE, M. K. & NICOLSON, S. C. 2019. Changes in Anesthetic and Postoperative Sedation–Analgesia Practice Associated With Early Extubation Following Infant Cardiac Surgery: Experience From the Pediatric Heart Network Collaborative Learning Study. Pediatric Critical Care Medicine, 20, 931-939.
  1. BAINBRIDGE, D. & CHENG, D. C. Early extubation and fast-track management of off-pump cardiac patients in the intensive care unit. Seminars in cardiothoracic and vascular anesthesia, 2015. SAGE Publications Sage CA: Los Angeles, CA, 163-168.
  2. BANSAL, S., THAI, H., HSU, C., SAI-SUDHAKAR, C., GOLDMAN, S. & RHENMAN, B. 2013. Fast track extubation post coronary artery bypass graft: a retrospective review of predictors of clinical outcomes. World Journal of Cardiovascular Surgery, 3, 81-86.
  3. BARKHORDARI, K., YAGHOOTI, S., NIKKHAH, S., AEIN, A., JALALI, A. & SHAFIEE, A. 2016. Clinical outcome of tracheal extubatedcardiac surgery patients who did not meet protocol driven laboratory criteria for extubation. Tehran University Medical Journal TUMS Publications, 74, 657-663.
  4. BASKAR KARTHEKEYAN, R., SYAMA SUNDAR, A., SULAIMAN, S., RAVULAPALLI, H., VAKAMUDI, M. & THANGAVELU, P. 2010. Early Extubation in Ventricular Septal Defect. Journal of Clinical & Experimental Cardiology, 1.
  5. BRIMS, F. J., DAVIES, M. G., ELIA, A. & GRIFFITHS, M. J. 2015. The effects of pleural fluid drainage on respiratory function in mechanically ventilated patients after cardiac surgery. BMJ open respiratory research, 2, e000080.
  6. CRAWFORD, T. C., MAGRUDER, J. T., GRIMM, J. C., SCIORTINO, C., CONTE, J. V., KIM, B. S., HIGGINS, R. S., CAMERON, D. E., SUSSMAN, M. & WHITMAN, G. J. Early extubation: a proposed new metric. Seminars in thoracic and cardiovascular surgery, 2016. Elsevier, 290-299.
  7. FAGHANI, H., MOSAVINASAB, N., GHOLIPOUR BARADARI, A., MOOSAZADEH, M., KHERADMAND, M. & ESMAEILI, R. 2017. Duration of Intubation after Coronary Artery Bypass Graft Surgery and Its Related Factors. Journal of Mazandaran University of Medical Sciences, 26, 68-79.
  8. FLYNN, B. C., HE, J., RICHEY, M., WIRTZ, K. & DAON, E. 2019. Early extubation without increased adverse events in high-risk cardiac surgical patients. The Annals of thoracic surgery, 107, 453-459.
  9. GUMUS, F., POLAT, A., YEKTAS, A., TOTOZ, T., BAGCI, M., ERENTUG, V. & ALAGOL, A. 2015. Prolonged mechanical ventilation after CABG: risk factor analysis. Journal of cardiothoracic and vascular anesthesia, 29, 52-58.
  10. JAFROUDI, S., MEHDIZADEH ATTAR, M., FARMANBAR, R., KAZEM NEJAD LEILI, E. & PARYAD, E. 2014. Predictors' issues of intubation time after coronary artery bypass graft surgery. Journal of Holistic Nursing And Midwifery, 24, 20-29.
  11. MADDALI, M. M., KURIAN, & FAHR, J. 2006. Extubation time, hemodynamic stability, and postoperative pain control in patients undergoing coronary artery bypass surgery: An evaluation of fentanyl, remifentanil, and nonsteroidal antiinflammatory drugs with propofol for perioperative and postoperative management. Journal of clinical anesthesia, 18, 605-610.
  12. MARDA, M., PANDIA, M. P., RATH, G. P., KALE, S. S. & DASH, H. 2016. A comparative study of early and late extubation following transoral odontoidectomy and posterior fixation. Journal of anaesthesiology, clinical pharmacology, 32, 33.
  13. MARTINOS, C., DALIAKOPOULOS, S., TSAKALAKIS, C., GEORGIOU, M. & MORAITIS, S. 2017. The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients. J Anesth Crit Care Open Access, 8, 00301.
  14. MIRINEZHAD, S. M., JOUDATI, A. R., SAFAEI, N., AZAR FARIN, R. & BILEHJANI, I. 2005. Early Extubation Following Coronary Artery Bypass Graft Surgery Protocol Versus Midazolam. Medical Journal of Tabriz University Of Medical Sciences, 27, 77-81.
  15. MUKERJI, A., RAZAK, A., AGGARWAL, A., JACOBI, E., MUSA, M., ALWAHAB, Z., BAIER, J., NARVEY, M. & SHAH, P. S. 2020. Early versus delayed extubation in extremely preterm neonates: a retrospective cohort study. Journal of Perinatology, 40, 118-123.
  16. MYLES, P. S., BUCKLAND, M. R., WEEKS, A. M., BUJOR, M. A., MCRAE, R., LANGLEY, M., MOLONEY, J. T., HUNT, J. O. & DAVIS, B. B. 1997. Hemodynamic effects, myocardial ischemia, and timing of tracheal extubation with propofol-based anesthesia for cardiac surgery. Anesthesia & Analgesia, 84, 12-19.
  17. NGUYEN, J. & NACPIL, N. 2018. Effectiveness of dexmedetomidine versus propofol on extubation times, length of stay and mortality rates in adult cardiac surgery patients: a systematic review and meta-analysis. JBI database of systematic reviews and implementation reports, 16, 1220-1239.
  18. RAMONCITO, D. A., BROOKE, B. S., HANSON, K. T., GOODNEY, P. P., GENOVESE, E. A., BARIL, D. T., GLOVICZKI, P. & DEMARTINO, R. R. 2017. Early extubation is associated with reduced length of stay and improved outcomes after elective aortic surgery in the Vascular Quality Initiative. Journal of vascular surgery, 66, 79-94. e14.
  19. REZAIANZADEH, A., MAGHSOUDI, B., TABATABAEE, H., KESHAVARZI, S., BAGHERI, Z., SAJEDIANFARD, J., GERAMI, H. & RASOULI, J. 2015. RFactors associated with extubation time in coronary artery bypass grafting patients. PeerJ e, 3.
  20. SAFAVI, M., M., M. & SADREDDINI, M. 2005. The effect of preoperative training and information on mechanical ventilation and device isolation in patients undergoing CABG in selected hospitals of Tabriz in 2004. Pajoohande, 10, 321-327.
  21. SATO, M., SUENAGA, E., KOGA, S., MATSUYAMA, S., KAWASAKI, H. & MAKI, F. 2009. Early tracheal extubation after on-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg, 15, 239-42.
  22. SAVARI, S., MOTEDAYEN, Z. & EBADI, A. 2013. Early Extubation in Cardiac Surgery. Journal of Medical Education Development Department, Faculty of Nursing, Baqiyatallah University of Medical Sciences, 14, 15-22.
  23. TIERNEY, C. C., OERMANN, M. H., MOLLOY, M. A., BRIEN, L. & NEISLER, C. 2019. Implementing a Weaning Protocol for Cardiac Surgery Patients Using Simulation: A Quality Improvement Project. Dimensions of Critical Care Nursing, 38, 248-255.
  24. WILLIAMS, A. & MURPHY, L. S. 2016. Establishing the Content Validity of an Early Extubation Protocol: A Quality Improvement Project for Improving Early Extubation of Coronary Artery Bypass Graft Patients. Journal of Doctoral Nursing Practice, 9, 236-248.
  25. WILLIAMSON, C., FITTON, T., SMAROFF, G., TEAGUE, P., SHAFF, D. & CURRAN, J. 2017. Early extubation protocol following valve and coronary artery bypass surgery. Clin Surg. 2017; 2, 1424.
  26. ZHOU, Y., JIN, X., KANG, Y., LIANG, G., LIU, T. & DENG, N. 2014. Midazolam and propofol used alone or sequentially for long-term sedation in critically ill, mechanically ventilated patients: a prospective, randomized study. Critical Care, 18, R122.