Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-25T20:58:18.910Z Has data issue: false hasContentIssue false
  • English
  • Français

Early extubation strategy after congenital heart surgery: 1-year single-centre experience

Published online by Cambridge University Press:  07 June 2021

Lyudmil Simeonov Open the ORCID record for Lyudmil Simeonov [Opens in a new window] ,
Dimitar Pechilkov ,
Anna Kaneva ,
Mary C. McLellan  and
Kathy Jenkins
Lyudmil Simeonov*
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Dimitar Pechilkov
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Anna Kaneva
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Mary C. McLellan
Affiliation:
Department of Cardiology, Children’s Hospital, Boston, MA, USA
Kathy Jenkins
Affiliation:
Department of Cardiology, Children’s Hospital, Boston, MA, USA
*
Author for correspondence: Lyudmil Simeonov, Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria. Tel: +359886848285. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Our aim was to present the initial experience with a protocol-driven early extubation strategy and to identify risk factors associated with failed spontaneous breathing trials within 12 hours after surgery.

Methods:

A single institutional retrospective study of children up to 18 years of age was conducted in post-operative cardiac surgical patients over a 1-year period. A daily spontaneous breathing trial protocol was used to assess patients’ readiness for extubation. The study population (n = 129) was stratified into two age groups: infants (n = 84) and children (n = 45), and further stratified according to ventilation time: early extubation (ventilation time less than 12 h, n = 86) and deferred extubation (ventilation time more than 12 h, n = 43). Mann–Whitney U-test and binomial logistic regression were used for statistical analysis.

Results:

Early extubated infants had shorter ICU (4 versus 6 days, p = 0.003) and hospital length of stays (16 versus 19 days, p = 0.006), lower re-intubation rates (1 versus 7 patients, p = 0.003), and lower mortality (0 versus. 4 patients, p = 0.01) than deferred extubated infants. There was no significant difference in the studied outcomes in the children group. Malnourished infants and longer cardiopulmonary bypass times were independently associated with failed spontaneous breathing trials within 12 hours after cardiac surgery.

Conclusions:

Early extubated infants after cardiac surgery had shorter ICU and hospital length of stay, without an increase in morbidity and mortality, compared to infants who deferred extubation. Nutritional status and longer cardiopulmonary bypass times were risk factors for failed spontaneous breathing trial.

Keywords

Early extubationcongenital heart surgeryextubation protocol
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022 , pp. 357 - 363
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hawkes, CA, Dhileepan, S, Foxcro, DR. Early extubation for adult cardiac surgical patients. Cochrane Database Syst Rev 2003; 4: CD003587.CrossRefGoogle Scholar
Durandy, YD, Younes, M, Mahut, B. Pediatric warm open heart surgery and prolonged cross-clamp time. Ann Thorac Surg 2008; 86: 1941–1947.CrossRefGoogle ScholarPubMed
Jin, HS, Yum, MS, Kim, SL, et al. The efficacy of the COMFORT scale in assessing optimal sedation in critically ill children requiring mechanical ventilation. J Korean Med Sci 2007; 22: 693–697.10.3346/jkms.2007.22.4.693CrossRefGoogle ScholarPubMed
Newth, CJ, Venkataraman, S, Willson, DF, et al. Weaning and extubation readiness in pediatric patients. Pediatr Crit Care Med 2009; 10: 1–11.10.1097/PCC.0b013e318193724dCrossRefGoogle ScholarPubMed
Abu-Sultaneh, S, Hole, AJ, Tori, AJ, et al. An interprofessional quality improvement initiative to standardize pediatric extubation readiness assessment. Pediatr Crit Care Med 2017; 10: 463–471.10.1097/PCC.0000000000001285CrossRefGoogle Scholar
Jenkins, KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180–184.CrossRefGoogle ScholarPubMed
World Health Organization. WHO child growth standards: methods and development. https://www.who.int/childgrowth/standards/technical_report/en/.Google Scholar
Preisman, S, Lembersky, H, Yusim, Y, et al. A randomized trial of outcomes of anesthetic management directed to very early extubation after cardiac surgery in children. J Cardiothorac Vasc Anesth 2009; 3: 348–357.CrossRefGoogle Scholar
Alam, S, Shalini, A, Hedge, RG, Mazahir, R, Jain, A. Predictors and outcome of early extubation in infants postcardiac surgery: a single-center observational study. Ann Card Anaesth 2018; 21: 402–406.CrossRefGoogle ScholarPubMed
Neirotti, RA, Jones, D, Hackbarth, R, Paxson Fosse, G. Early extubation in congenital heart surgery. Heart Lung Circ 2002; 11: 157–161.CrossRefGoogle ScholarPubMed
Barash, PG, Lescovich, F, Katz, JD, Talner, NS, Stansel, HC Jr Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg 1980; 3: 228–233.CrossRefGoogle Scholar
Alghamdi, AA, Singh, SK, Hamilton, BC, et al. Early extubation after pediatric cardiac surgery: systematic review, meta-analysis, and evidence-based recommendations. J Card Surg 2010; 5: 586–595.CrossRefGoogle Scholar
Vricella, LA, Dearani, JA, Gundry, SR, Razzouk, AJ, Brauer, SD, Bailey, LL. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg 2000; 69: 865–871.CrossRefGoogle ScholarPubMed
Heinle, JS, Diaz, LK, Fox, LS. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg 1997; 114: 413–418.CrossRefGoogle ScholarPubMed
Shinkawa, T, Tang, X, Gossett, JM, et al. Incidence of immediate extubation after pediatric cardiac surgery and predictors for reintubation. World J Pediatr Congenital Heart Surg 2018; 9: 529–536.CrossRefGoogle ScholarPubMed
Gupta, P, Rettiganti, M, Gossett, JM, et al. Risk factors for mechanical ventilation and reintubation after pediatric heart surgery. J Thorac Cardiovasc Surg 2016; 151: 451–458. Davis S, Worley S, Mee RB, Harrison AM. Factors associated with early extubation after cardiac surgery in young children. Pediatr Crit Care Med. 2004; 5: 63–8.CrossRefGoogle ScholarPubMed
Székely, A, Sápi, E, Király, L, Szatmári, A, Dinya, E. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth 2006; 16: 1166–1175.Google ScholarPubMed
Benneyworth, BD, Mastropietro, CW, Graham, EM, et al. Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals. J Thorac Cardiovasc Surg 2017; 153: 1519–1526.CrossRefGoogle ScholarPubMed