Key result
Ventilator weaning guided by capnography and pulse oximetry significantly increased the likelihood of fast track extubation (OR 4.8) and reduced mean extubation time compared to arterial blood gas analysis in patients undergoing CABG surgery.
Why the study?
The use of capnography during weaning for fast track extubation is controversial, prompting evaluation of capnography and pulse oximetry as alternatives to arterial blood gas measurements after CABG.
Does ventilator weaning using capnography and pulse oximetry reduce time to extubation and ICU stay in patients undergoing CABG surgery compared to ABG analysis?
RCT (n=70)
Open-label
Random block sizes of 2 and 4
No
Does ventilator weaning using capnography and pulse oximetry reduce time to extubation and ICU stay in patients undergoing CABG surgery compared to ABG analysis?
Odds Ratio: 4.8 (95% CI 1.4–15.5)
Absolute Event Rate: 97.1% vs 54.5%
p-value: p=0.008
Non-invasive monitoring with capnography and pulse oximetry safely accelerates fast-track extubation in post-CABG patients compared to routine ABG analysis.
Enables faster extubation after CABG with fewer interventions; extends RCT evidence for capnography as ABG alternative in weaning.
Background Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35); the intervention group and the control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilator setting changes, and alarms were compared between the groups. Results The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, P > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, P < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were lower in the intervention group ( P < 0.05). However, the differences in the length of stay in ICU between the two groups were not significant ( P = 0.219). Conclusion According to our results, the use of non-invasive monitors, including capnography and pulse oximetry, is emphasized in order to utilize FTE after CABG surgery. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Nevertheless, further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Trial registration: IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192
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Moradian et al. (2021) conducted an RCT in Coronary artery bypass graft (CABG) surgery (n=70). Capnography and pulse oximetry vs. Arterial blood gas (ABG) analysis was evaluated on Fast track extubation (mechanical ventilation duration < 6 hours) (OR 4.8, 95% CI 1.4-15.5, p=0.008). Ventilator weaning guided by capnography and pulse oximetry significantly increased the likelihood of fast track extubation (OR 4.8) and reduced mean extubation time compared to arterial blood gas analysis in patients undergoing CABG surgery.
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