EARLY EXTUBATION VERSUS PROPHYLACTIC VENTILATION IN THE HIGH-RISK PATIENT - A COMPARISON OF POSTOPERATIVE MANAGEMENT IN THE PREVENTION OF RESPIRATORY COMPLICATIONS

Abstract

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 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 0800 of the 1st 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 O2 delivery were compared to similar measurements during the initial 2 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 h. Patients in the early extubation group were ventilated for an average of 3.3 .+-. 0.5 h (P < 0.0005). No patient in either group required reintubation. Intrapulmonary shunt and O2 delivery were not significantly different between the groups at any time. There was no mortality or significant morbidity in either group. In high risk surgical patients, prophylactic ventilation, per se, may not diminish respiratory complications or improve gas exchange.