Enhancing recovery protocols seek to optimize multiple aspects of care throughout the patient’s perioperative cardiac surgery journey. Fast-track recovery protocols, specifically those involving earlier extubation, have been among the early methods to enhance a patient’s recovery. However, how early these protocols should be implemented after surgery remains a source of ongoing controversy. Strong opinions exist on whether it is appropriate to extubate patients after cardiac surgery in the operating room (OR). Although OR extubation may offer benefits such as reduced intensive care unit length of stay and resource utilization, there are concerns regarding safety, patient selection, and inconsistent outcomes, which have raised significant controversy. This review aims to discuss the reasons why a team may consider exploring extubation in the OR and provide a practical approach for the interdisciplinary team seeking to implement this practice in appropriately selected patients.
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