Cochrane · systematic review · CD003587
Fast‐track cardiac care for adult cardiac surgical patients
Wong, WT, Lai, VKW, Chee, YE, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
14
current version
GRADE rated
14
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 0 · 0%Low 14 · 100%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyLow‐dose opioid‐based GA vs high‐dose opioid‐based GA
Population: adult cardiac surgical patients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality ‐ Death at any time after surgery Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | OR 0.53 [0.25, 1.12] | 8 studies · 1994 participants | Low Downgraded: risk of bias |
Postoperative myocardial infarction Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | RR 0.98 [0.48, 1.99] | 8 studies · 1683 participants | Low Downgraded: risk of bias |
Postoperative stroke Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | RR 1.17 [0.36, 3.78] | 5 studies · 562 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative tracheal reintubation Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | RR 1.77 [0.38, 8.27] | 5 studies · 594 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Time to extubation (hours) Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | no estimate extracted | 14 studies · 2486 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Length of intensive care unit stay (hours) Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | no estimate extracted | 12 studies · 1394 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Length of hospital stay (days) Low‐dose opioid‐based GA vs high‐dose opioid‐based GA | no estimate extracted | 8 studies · 913 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Time‐directed extubation protocol vs usual care
Population: adult cardiac surgical patients
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Mortality ‐ Death at any time after surgery Time‐directed extubation protocol vs usual care | OR 0.8 [0.45, 1.45] | 10 studies · 1802 participants | Low Downgraded: risk of bias |
Postoperative myocardial infarction Time‐directed extubation protocol vs usual care | RR 0.59 [0.27, 1.31] | 8 studies · 1378 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative stroke Time‐directed extubation protocol vs usual care | RR 0.85 [0.33, 2.16] | 11 studies · 1646 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Postoperative reintubation Time‐directed extubation protocol vs usual care | RR 1.34 [0.74, 2.41] | 12 studies · 1261 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Time to extubation (hours) Time‐directed extubation protocol vs usual care | no estimate extracted | 16 studies · 2024 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Length of intensive care unit stay (hours) Time‐directed extubation protocol vs usual care | no estimate extracted | 13 studies · 1888 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Length of hospital stay (days) Time‐directed extubation protocol vs usual care | no estimate extracted | 8 studies · 1334 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Low‐dose opioid based general anaesthesia compared to high‐dose opioid based general anaesthesia for adults undergoing cardiac surgery
Population: Adults undergoing cardiac surgery (coronary artery bypass grafts, aortic valve replacement, mitral valve replacement)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death after surgery From intensive care unit stay to 1 year after surgery Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | RR 0.58 [0.28, 1.18] | 8 studies · 1994 participants | Moderate Downgraded: risk of bias, publication bias |
Postoperative complications ‐ Myocardial infarction Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | RR 0.98 [0.48, 1.99] | 8 studies · 1683 participants | Moderate Downgraded: risk of bias |
Postoperative complications ‐ Stroke Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | RR 1.17 [0.36, 3.78] | 5 studies · 562 participants | Moderate Downgraded: risk of bias |
Postoperative complications ‐ Tracheal reintubation Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | RR 1.77 [0.38, 8.27] | 5 studies · 594 participants | Moderate Downgraded: risk of bias |
Time to extubation (hours) Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | no estimate extracted | 14 studies · 2486 participants | Low Downgraded: risk of bias, inconsistency |
Length of Intensive Care Unit Stay (hours) Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | no estimate extracted | 12 studies · 1394 participants | Low Downgraded: risk of bias, inconsistency |
Length of Hospital Stay (days) Low‐dose opioid based general anaesthesia vs high‐dose opioid based general anaesthesia | no estimate extracted | 8 studies · 913 participants | Low Downgraded: risk of bias, inconsistency |
Time‐directed extubation protocol compared to usual care for adults undergoing cardiac surgery
Population: Adults undergoing cardiac surgery (coronary artery bypass surgery, aortic valve replacement, mitral valve replacement)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Death after surgery From intensive care unit stay to 1 year after surgery Time‐directed extubation protocol vs usual care | RR 0.84 [0.4, 1.75] | 8 studies · 1541 participants | Moderate Downgraded: risk of bias, publication bias |
Postoperative complications ‐ Myocardial infarction Time‐directed extubation protocol vs usual care | RR 0.94 [0.55, 1.6] | 7 studies · 1326 participants | Moderate Downgraded: risk of bias |
Postoperative complications ‐ Stroke Time‐directed extubation protocol vs usual care | RR 0.87 [0.31, 2.46] | 9 studies · 1385 participants | Moderate Downgraded: risk of bias |
Postoperative complications ‐ Reintubation Time‐directed extubation protocol vs usual care | RR 1.91 [0.9, 4.07] | 9 studies · 948 participants | Moderate Downgraded: risk of bias |
Time to extubation (hours) Time‐directed extubation protocol vs usual care | no estimate extracted | 13 studies · 1713 participants | Low Downgraded: risk of bias, inconsistency |
Length of Intensive Care Unit Stay (hours) Time‐directed extubation protocol vs usual care | no estimate extracted | 10 studies · 1575 participants | Low Downgraded: risk of bias, inconsistency |
Length of Hospital Stay (days) Time‐directed extubation protocol vs usual care | no estimate extracted | 6 studies · 1073 participants | Low Downgraded: risk of bias, inconsistency |