Factors Associated With Early Extubation After Cardiac Surgery: A Retrospective Single-Center Experience.

OBJECTIVES: To identify factors associated with early extubation in cardiac surgery patients. DESIGN: Single center, retrospective. SETTING: Tertiary university hospital. PARTICIPANTS: The study comprised 8,872 adult patients who underwent cardiothoracic surgery from 2011-2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 8,872 patients, 2,950 (33%) were extubated within six hours after surgery. Early extubated patients were younger, had a higher body mass index (BMI), were more likely to be male, and were fast-track designated. These patients more frequently underwent isolated coronary artery bypass graft, isolated valve, or adult congenital surgeries than did late extubated patients. Early extubated patients had a greater incidence of coronary artery disease (CAD) and anxiety and a higher left ventricular ejection fraction. They also were less likely to have difficult intubation or require mechanical circulatory support, reintubation, or readmission. Analysis of the 8,872 patients showed that male sex (odds ratio [OR] 1.222, 95% confidence interval [CI] 1.096-1.363), a BMI >30 kg/m2 (OR 1.702, 95% CI 1.475-1.965), undergoing isolated valve surgery (OR 1.187, 95% CI 1.060-1.328), and having a fast-track designation (OR 1.455, 95% CI 1.208-1.751) and CAD (OR 1.122, 95% CI 1.005-1.253) were associated with early extubation. Data on intensive care unit (ICU) admission after surgery were available only from 2014-2018. Within this subgroup of 5,977 patients, variables associated with early extubation included male sex (OR 1.356, 95% CI 1.193-1.541), BMI >30 kg/m2 (OR 1.267, 95% CI 1.084-1.480), daytime admission to the ICU (OR 1.712, 95% CI 1.527-1.919), and fast-track designation (OR 1.423, 95% CI 1.123-1.802). CONCLUSIONS: Male sex; a BMI >30 kg/m2; undergoing isolated valve surgery; and having a fast-track designation, CAD, and daytime admission to the ICU are associated with early extubation.

Mitigation of building-related polychlorinated biphenyls in indoor air of a school.

BACKGROUND: Sealants and other building materials sold in the U.S. from 1958 - 1971 were commonly manufactured with polychlorinated biphenyls (PCBs) at percent quantities by weight. Volatilization of PCBs from construction materials has been reported to produce PCB levels in indoor air that exceed health protective guideline values. The discovery of PCBs in indoor air of schools can produce numerous complications including disruption of normal operations and potential risks to health. Understanding the dynamics of building-related PCBs in indoor air is needed to identify effective strategies for managing potential exposures and risks. This paper reports on the efficacy of selected engineering controls implemented to mitigate concentrations of PCBs in indoor air. METHODS: Three interventions (ventilation, contact encapsulation, and physical barriers) were evaluated in an elementary school with PCB-containing caulk and elevated PCB concentrations in indoor air. Fluorescent light ballasts did not contain PCBs. Following implementation of the final intervention, measurements obtained over 14 months were used to assess the efficacy of the mitigation methods over time as well as temporal variability of PCBs in indoor air. RESULTS: Controlling for air exchange rates and temperature, the interventions produced statistically significant (p < 0.05) reductions in concentrations of PCBs in indoor air of the school. The mitigation measures remained effective over the course of the entire follow-up period. After all interventions were implemented, PCB levels in indoor air were associated with indoor temperature. In a "broken-stick" regression model with a node at 20 °C, temperature explained 79% of the variability of indoor PCB concentrations over time (p < 0.001). CONCLUSIONS: Increasing outdoor air ventilation, encapsulating caulk, and constructing a physical barrier over the encapsulated material were shown to be effective at reducing exposure concentrations of PCBs in indoor air of a school and also preventing direct contact with PCB caulk. In-place management methods such as these avoid the disruption and higher costs of demolition, disposal and reconstruction required when PCB-containing building materials are removed from a school. Because of the influence of temperature on indoor air PCB levels, risk assessment results based on short-term measurements, e.g., a single day or season, may be erroneous and could lead to sub-optimal allocation of resources.