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Critically ill patients are frequently extubated to prevent postoperative atelectasis, but the value of extubation before emergence from anesthesia is controversial. In a prospective randomized study, patients undergoing cardiac surgery were randomly assigned to extubation before emergence from anesthesia (the “early” group) or after emergence from anesthesia, without extubation during the recovery room (the “late” group). The primary outcome variable was the incidence of postoperative pulmonary dysfunction in intensive care, determined on postoperative day 1 by measuring arterial blood gases and measuring the change in forced expiratory volume. Ventilation indexes and PaCO2, ventilatory pressures, and minute volume were measured for days 3 and 5. Information was obtained on routine physiologic parameters, cardiopulmonary bypass time, duration of operation, laboratory tests, and complications. A total of 111 patients were enrolled in the study. Patients in the early group were extubated earlier than were patients in the late group (5.8+/-0.8 hours vs. 6.4+/-0.5 hours). Postoperative plasma lactate and creatinine clearances were similar in the two groups, and no difference in PaCO2, minute ventilation, and ventilation indexes was detected. The incidence of pulmonary dysfunction was reduced in patients who were extubated earlier, and no difference in PaO2/FIO2 was detected. By the third postoperative day, PaCO2 was 6.7+/-0.7 kPa in the early group and 6.9+/-0.6 kPa in the late group (p = 0.52). The primary outcome variable was not significantly improved. However, postoperative PaCO2 was decreased more in the early group than in the late group (6.7+/-0.7 kPa vs. 7.5+/-0.8 kPa; p = 0.03). Early extubation, without a conscious state, does not improve outcomes in critically ill patients after cardiac surgery compared with late extubation after emergence from anesthesia.Q: