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Association between preoperative respiratory support and outcomes in paediatric cardiac surgery

Published online by Cambridge University Press:  27 November 2019

Elizabeth C. Ciociola ,
Karan R. Kumar ,
Kanecia O. Zimmerman ,
Elizabeth J. Thompson ,
Melissa Harward ,
Laura N. Sullivan ,
Joseph W. Turek  and
Christoph P. Hornik Open the ORCID record for Christoph P. Hornik [Opens in a new window]
Elizabeth C. Ciociola
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
Karan R. Kumar
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Kanecia O. Zimmerman
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Elizabeth J. Thompson
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Melissa Harward
Affiliation:
Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
Laura N. Sullivan
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Joseph W. Turek
Affiliation:
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Christoph P. Hornik*
Affiliation:
Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
*
Author for correspondence: C. P. Hornik, MD, MPH, Duke Clinical Research Institute, Durham, NC 27705, USA. Tel: (919) 668-8935; Fax: (919) 668-7032; E-mail: christoph.hornik@duke.edu
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Abstract

Background:

Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes.

Methods:

We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates.

Results:

A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2–11.4) and neonates (odds ratio = 8.97, 95% CI 1.31–61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air.

Conclusion:

Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

Keywords

CHDpreoperative ventilationpaediatric cardiac surgeryrespiratory supportnoninvasive ventilationpostoperative length of stay
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 66 - 73
Copyright
© Cambridge University Press 2019

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