Factors associated with early extubation after cardiac surgery in young children

Davis, Steve; Worley, Sarah; Mee, Roger B.B.; Harrison, A. Marc

doi:10.1097/01.pcc.0000102386.96434.46

Cited by 96 publications

(89 citation statements)

References 25 publications

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“…Indeed, some reports have suggested that OR extubation is successful in cases when the CPB duration is less than 150 minutes or the aortic cross clamp duration is less than 45 minutes. 3,10) Older age is also an important factors associated with the success rate of extubation in the OR. Several reports have stated that the majority of patients older than 6 months were successfully extubated in the OR.…”

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

“…[10][11][12] Some reports have suggested that PH be evaluated as mean pulmonary artery pressure (MPAP) divided by mean systemic arterial pressure (MSAP) before and after cardiac surgery. Vida and colleagues 13) reported in 2006 that PH did not seem to be a contra-indication to early extubation after VSD closure, and reported that 65% of their cases (65/100, including those with preoperative MPAP/MSAP < 0.6; extubation rate, 84.6%) were successfully extubated in the OR.…”

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

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Early Extubation in the Operating Room after Congenital Open-Heart Surgery

et al. 2018

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SummaryEarly extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.(Int Heart J 2018; 59: 94-98)

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Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

Early Extubation in the Operating Room after Congenital Open-Heart Surgery

et al. 2018

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“…The incapacity to sustain spontaneous respiration after extubation has been one of the main factors of failure in extubation [10,[21][22][23][24]. The inexistence of validated extubation protocols adequate for children undergoing correction surgery of congenital heart diseases collaborates with the increase in failure rates during weaning of these patients [18,[21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Recently it was demonstrated that extubation failure, with consequent re-intubation within 48 hours, is associated with a higher mortality rate compared to successful weaning [17,23,24].…”

Section: Discussionmentioning

confidence: 99%

Fatores associados ao insucesso no desmame ventilatório de crianças submetidas a cirurgia cardíaca pediátrica

Silva

Pérez²,

Pinzon³

et al. 2008

Rev Bras Cir Cardiovasc

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“…Study of the Neirotti et al (15) showed, as well as our research, that failure to thrive is one of the risk factor of prolonged ventilation [95%CI (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)]. …”

mentioning

confidence: 99%