Con: early extubation is not preferable to late extubation in patients undergoing coronary artery surgery.

T HERE HAS again arisen a trend to extubate patients within a few hours after cardiac surgery rather than continuing mechanica1 ventilation until the following morning.* Potential advantages of early termination of mechanical ventilation include shorter intensive care unit (ICU) stays, earlier patient mobilization, less lobar collapse and pneumonia, avoidance of endotracheal tube and ventilator malfunction, and decreased intrapleural pressures with resultant increased ventricular filling and improved cardiac output (CO). Surely this not only sounds reasonable, but appears to be a further advance in cardiac surgery. But is this technique appropriate for the patients who make up the cardiac surgery population in the 199Os? And, is this technique as benign as it seems when new biochemical, physiologic, hemodynamic, and ischemic data are considered that suggest that extubation during the early postoperative period might not be in the best interests of the patients?