Patients’ Selection

This chapter focuses on factors that could help clinicians in the selection of patients that may benefit (or not) from “fast-track” extubation after cardiac surgery, which is defined as extubation achieved within 6 h from intensive care unit arrival. Proper selection may improve the patient’s perioperative experience and promote enhanced recovery after surgery, reducing intensive care and hospital costs. The decision of targeting a “fast-track” extubation should be made in the preoperative period in consideration of the patient’s demographic and comorbidities (including ongoing therapy), type of surgical intervention, and predicted duration of cardiopulmonary bypass. When targeting “fast-track” extubation, cardiac anesthesiologists should prompt approaches expediting recovery (i.e., using locoregional anesthesia and administering low doses of opioids). However, even in patients apparently eligible for “fast-track” extubation, cardiac anesthesiologists should be watchful on a series of intra- and postoperative factors that may hamper this target. Bleeding, metabolic acidosis, high cardiovascular support, and deterioration in gas exchanges are just some of the possible complications that should refrain clinicians from rapidly awakening the patient and promoting “fast-track” extubation. Hence, even in the presence of positive predictors for “fast-track” extubation, clinicians should confirm its postoperative appropriateness with a proactive detection of perioperative complications. It would be advisable to develop scores balancing the impact of different factors, in order to guide clinicians willing to implement “fast-track” extubation in cardiac surgery. The use of large databases and artificial intelligence may help in such objectives.