Does early removal of breathing support reduce complications in patients who have had surgery for bleeding on the brain?

INTERVENTION: Early extubation, also known as fast track, is desirable after intracranial hematoma surgery to avoid ventilator‐associated complications associated with admission to an intensive care unit (ICU). The objective of the present study was to determine whether ICU stay and ventilator‐associated complications are reduced in patients who received surgery for intracranial hematoma if they are extubated early. A total of 17 patients were randomly assigned to two groups: In Group 1, patients were extubated early or using the fast‐track method Those in Group 2 were transferred to the ICU and extubated at 8 h post‐operatively. Patients programmed to receive a cranial surgery were invited to participate into this trial. Patients from the two groups were assessed on admission to the operating room according to established standards and general anesthesia was induced with propofol (2 mg/kg) and fentanyl (2 µg/kg). Extubation time and hemodynamic stability (number of anesthetic adjustments required to maintain hemodynamic parameters within 20% of the predicted values) were assessed post‐operatively. Patients were extubated when the following criteria were fulfilled: Regular breathing, without intercostal retraction and with a respiratory rate of >8 BPM, a telespiratory CO2 pressure of 95% with an inspired oxygen fraction of 100%, presence of a swallowing reflex, hemodynamic stability (a change in baseline blood pressure of =15 mm Hg), and a cooperative and oriented patient able to respond to verbal instructions. Attempted fast‐track extubation was performed after post‐operative neurological assessment by the same responsible surgeon. The difference between the two groups was in extubation time criteria; extubation was 8 h after surgery in the conventional group, but extubation was immediately post‐surgical in the fast‐track group. CONDITION: Early extubation to prevent ventilator‐associated complications following intracranial hematoma surgery ; Respiratory PRIMARY OUTCOME: Extubation procedure time SECONDARY OUTCOME: ; 1. Blood pressure, heart rate, respiratory rate and oxygen saturation measured with an S / 5 anesthesia monitor (GE, Datex / Ohmeda) during the entire surgical procedure and the subsequent 24 h; 2. Arterial pH measured every 8 h for 24 h using the Cobas B 221 blood gas analyzer (Roche); INCLUSION CRITERIA: 1. Patients about to receive open cranial surgery due to an intracranial hematoma 2. Anesthesia risk of I‐III according to the American Society of Anesthesiologists (ASA) 3. Aged 18 years or over 4. No intubation prior to entering the operating room 5. Glasgow coma score of =8