Early extubation after congenital heart surgery

Halimic, Mirza; Dinarevic, Senka Mesihovic; Begić, Zijo; Kadić, Aida Salihagić; Pandur, Sanko; Omerbašić, Edin

doi:10.17532/jhsci.2014.165

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…In a five-year cohort study of infants post repair for transposition of great arteries, greater CPB and cross-clamp times and minimum temperatures less than or equal to 30.4 degrees centigrade were associated with a lesser likelihood of IE [13]. Another five-year study demonstrated an inverse relationship between age and CPB time and early extubation [14].…”

Section: Discussionmentioning

confidence: 99%

Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery

Tirotta

Alcos

Lagueruela

et al. 2020

J Cardiothorac Surg

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BackgroundIn pediatric cardiac anesthesiology, there is increased focus on minimizing morbidity, ensuring optimal functional status, and using health care resources sparingly. One aspect of care that has potential to affect all of the above is postoperative mechanical ventilation. Historically, postoperative ventilation was considered a must for maintaining patient stability. Ironically, it is recognized that mechanical ventilation may increase risk of adverse outcomes in the postoperative period. Hence, many institutions have advocated for immediate extubation or early extubation after many congenital heart surgeries which was first reported decades ago.Methods637 consecutive patient charts were reviewed for pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. Patients were placed into three groups. Those that were extubated in the operating room (OR) at the conclusion of surgery (Immediate Extubation or IE), those that were extubated within six hours of admission to the ICU (Early Extubation or EE) and those that were extubated sometime after six hours (Delayed Extubation or DE). Multiple variables were then recorded to see which factors correlated with successful Immediate or Early Extubation.ResultsOverall, 338 patients (53.1%) had IE), 273 (42.8%) had DE while only 26 patients (4.1%) had EE. The median age was 1174 days for the IE patients, 39 days for the DE patients, whereas 194 days for EE patients (p < 0.001). Weight and length were also significantly different in at least one extubation group from the other two (p < 0.001). The median ICU LOS was 3 and 4 days for IE and EE patients respectively, whereas it was 9.5 days for DE patients (p < 0.001). DE group had a significant longer median anesthesia time and cardiopulmonary bypass time than the other two extubation groups (p > 63,826.88 < 0.001). Regional low flow perfusion, deep hypothermia, deep hypothermic circulatory arrest, redo sternotomy, use of other sedatives, furosemide, epinephrine, vasopressin, open chest, cardiopulmonary support, pulmonary edema, syndrome, as well as difficult intubation were significantly associated with delayed extubation (IE, EE or DE).ConclusionsImmediate and early extubation was significantly associated with several factors, including patient age and size, duration of CPB, use of certain anesthetic drugs, and the amount of blood loss and blood replacement. IE can be successfully accomplished in a majority of pediatric patients undergoing surgery for congenital heart disease, including in a minority of infants.

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Section: Discussionmentioning

confidence: 99%

Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery

Tirotta

Alcos

Lagueruela

et al. 2020

J Cardiothorac Surg

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Relation between right ventricular function and the time of extubation after total repair of tetralogy of fallot in the pediatirc population

Abdelhameed¹,

Ibraheem²,

Abdeltawab³

et al. 2020

IJCA

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To study the relation between the systolic and diastolic right ventricular (RV) function in relation to the time of extubation after total repair of tetralogy of Fallot (TOF) in a pediatric population. Prospective, descriptive, non-randomized study. Pediatric cardiac surgery unit at Ain Shams University Hospitals, Cairo, Egypt. The study was conducted from January 2016 to February 2018. A total of 60 patients having elective primary total repairs of TOF made up the study sample. The patients were divided into two groups based on the time of extubation: Group I included patients who were extubated 6 hours or more after the procedure, while Group II included patients who were extubated within the first 6 hours. Total corrective surgery involving open-heart surgery with cardiopulmonary bypass. Measurements and Main Results: Early outcomes of mortality and morbidity were evaluated. RV systolic and diastolic functions were evaluated in the routine echocardiography performed on the first and fifth postoperative days. Additionally, patients’ inotropic drug requirements during their intensive care unit (ICU) stays were calculated to produce the inotropic index for evaluation of postoperative low cardiac output. Group I contained 32 patients, while Group II contained 28. The mean ages in Group I and II, respectively, were 1.2 ± 0.8 years and 1.5 ± 0.9 years (p = 0.180). The mean weight in Group I and II, respectively, was 10.5 ± 2.5 kg and 9.86 ± 3.2 kg (p = 0.396). There were 20 (62.5%) males in Group I and 18 (64.29%) males in Group II (p = 0.886). Mortality was 2 cases (6.3%) in Group I and 1 case (3.6%) in Group II, with no statistical difference. Postoperative echocardiographic examination revealed significantly better RV functional parameters in Group II than in Group I.

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Early extubation after congenital heart surgery

Cited by 2 publications

References 19 publications

Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery

Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery

Relation between right ventricular function and the time of extubation after total repair of tetralogy of fallot in the pediatirc population

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