Table 5.
Clinical risk assessment form for delayed extubation following cardiac surgery.
| Clinical risk assessment form | |||||
|---|---|---|---|---|---|
| Patient name: | Assessors: | Date of assessment: | |||
| Introductions: For each item below, place a tick (√) in the box that matches the information of the patient undergoing cardiac surgery | |||||
| 1. Age: < 40 | □ 0 | 5. Type of operation: CABG only | □ 0 | 8. Duration of surgery: < 3 h | □ 0 |
| 40–49 | □ 2 | Valve only | □ 1 | 3–5 h | □ 3 |
| 50–59 | □ 3 | Aortic only | □ 4 | 5–7 h | □ 3 |
| 60–69 | □ 6 | CABG + valve | □ 3 | ≥ 7 h | □ 8 |
| ≥ 70 | □ 9 | Valve + aortic | □ 4 | 9. Use of IABP | □ 13 |
| 2. BMI ≥ 28 kg/m2 | □5 | CABG + aortic | □ 5 | 10. Preoperative eGFR < 60mL/min/1.73m2 | □ 4 |
| 3. EF < 50% | □ 6 | 6. Emergency surgery | □5 | Total points: | |
| 4. History of cardiac surgery | □ 5 | 7. CPB ≥ 120 min | □ 5 | ||
| Identification of risk level: | □Low (0–8 points) | □Medium (9–12 points) | □High (≥ 13 points) | ||
BMI, body mass index; EF, ejection fraction; CABG, coronary artery bypass grafting; CPB, cardiopulmonary bypass; IABP, intra-aortic balloon pump; eGFR, estimated glomerular filtration rate.