Should early extubation be the goal for children after congenital cardiac surgery?

Harris, Kevin C.; Holowachuk, Spencer; Pitfield, Alexander F.; Sanatani, Shubhayan; Froese, Norbert; Potts, James E.; Gandhi, Sanjiv K.

doi:10.1016/j.jtcvs.2014.06.093

Cited by 115 publications

(133 citation statements)

References 17 publications

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“…The little contribution of the thoracic cage to respiratory function, the relatively weak intercostal muscles, and narrower airway in these age groups were shown to be the anatomical and physiologic reasons for the risk of prolonged MV [7]. Lower body weight and failure to thrive were also risk factors for prolonged MV possibly associated with the same reasons above-mentioned [6,19,20]. Similar to previous reports, younger patient age and lower body weight were associated with prolonged MV in our study.…”

Section: Discussionsupporting

confidence: 89%

“…Considering these unfavorable effects of prolonged MV, there has been a paradigm shift in the postoperative management, from slow weaning from MV to promote early extubation (EE), ambulation, and hospital discharge [5]. Although the term ''early extubation'' generally refers to tracheal extubation in the operating room or within the first 6-8 h of PICU admission, some centers extend this period up to 24 h [6]. Previous studies showed that EE results in fewer complications, shortens the length of PICU and hospital stay, is cost-effective, and is safe and possible in carefully selected patients [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Although the term ''early extubation'' generally refers to tracheal extubation in the operating room or within the first 6-8 h of PICU admission, some centers extend this period up to 24 h [6]. Previous studies showed that EE results in fewer complications, shortens the length of PICU and hospital stay, is cost-effective, and is safe and possible in carefully selected patients [6][7][8]. Nonetheless, there is considerable variation in practice between institutions because assessment of extubation readiness in children after cardiac surgery is difficult, and extubation failure is associated with increased morbidity and mortality in these patients [9,10].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

et al. 2016

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This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (p = .009), greater body weight (p = .009), absence of preoperative pulmonary hypertension (p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass (p = .008) and cross-clamp (p = .022) times, lower PRISM III-24 (p < .05) and PELOD (p < .05) scores, lower inotropic score (p < .05) and vasoactive-inotropic score (p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

et al. 2016

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“…[1] The form of the cardiac pathology, the complexity of the operation, surgical complications, the presence of residual defects, myocardial dysfunction, presence of pulmonary parenchyma, and comorbid problems may complicate extubation, thereby, increasing the length of stay on the mechanical ventilator. [2][3][4] Prolonged endotracheal intubation complicates postoperative procedures, leading to increased mortality and morbidity rates.…”

mentioning

confidence: 99%

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Saygı¹,

Özden²,

Öztürk³

et al. 2016

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada trakeostomi uygulanan pediyatrik kardiyak yoğun bakım ünitesindeki hastalara ilişkin veriler analiz edildi.Ça lış m a pla nı: Ocak 2010 -Ocak 2015 tarihleri arasında tek bir merkezde pediyatrik kardiyak yoğun bakım ünitesinde yatan ve hastanede yatış döneminde trakeostomi uygulanan toplam 18 hasta (10 kız, 8 erkek; ort. yaş 9.4±10.5 ay; dağılım 2-42 ay) retrospektif olarak incelendi.Bul gu lar: Başlangıçta üç hastada genetik bozukluk saptandı. Kardiyak cerrahi uygulanan 1450 hastanın 10'una total düzeltme ve sekizine palyasyon yapıldı. Trakeostomi uygulanmadan geçen ortalama entübasyon süresi 41.0±12.9 gün ve ekstübasyon girişimi sayısı 4.2±0.8 idi. İki hastada nörolojik hasar vardı. Trakeostomi sonrası hastaların hiçbirinde pnömomediastinum, pnömotoraks, yara yeri enfeksiyonu ya da mediastinit gelişmedi. Bir hastada kanama nedeniyle trakeostomi revizyonu yapıldı. Hastaların hiçbirinde takip döneminde trakeal darlık gibi geç dönem trakeostomi komplikasyonları gözlenmedi. On sekiz trakeostomi hastasının altısı pediyatrik kardiyak yoğun bakım ünitesinde ve biri ise taburculuk sonrasında evde kaybedildi (mortalite %38.8). Taburcu edilen 12 trakeostomi hastasının sekizine dekanülasyon yapıldı. Üç hasta halen ev tipi ventilatör ile evde takip edilmektedir. So nuç:Trakeostomi işlemleri kardiyak cerrahi sonrası entübasyon süresi uzamış olan hastalarda düşük komplikasyon oranı ile uygulanabilir. Ancak, bu karmaşık süreçte rol oynayan çeşitli faktörler nedeniyle, morbidite ve mortalite oranı bu hasta popülasyonunda halen yüksek seyretmektedir.Anah tar söz cük ler: Kardiyak cerrahi; çocuk, pediyatrik kardiyak yoğun bakım ünitesi; uzamış entübasyon; trakeostomi. ABSTRACT Background:In this study, we analyzed the data related to pediatric cardiac intensive care unit patients undergoing tracheostomy.

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“…Implementation of a comprehensive early 161 extubation strategy for all children with congenital heart disease is associated with low morbidity rates and short length of stay. Although there are many benefits resulting from early extubation, it is important to ensure that the practice is both successful and safe (21,22). The majority of children undergoing congenital heart surgery can be extubated in the operating room, but there is question of its benefit and drawback in comparison with extubation couple hours after operation.…”

mentioning

confidence: 99%

Early extubation after congenital heart surgery

Halimic¹,

Dinarevic²,

Begić³

et al. 2014

JHSCI

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Should early extubation be the goal for children after congenital cardiac surgery?

Cited by 115 publications

References 17 publications

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Evaluation of tracheostomy patients in a pediatric cardiac intensive care unit: our five-year single-center experiences

Early extubation after congenital heart surgery

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