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Association of post-operative ICU requirements with early extubation in the fontan procedure

Published online by Cambridge University Press:  12 July 2023

Keriann L. Potter Open the ORCID record for Keriann L. Potter [Opens in a new window] ,
Marc E. Richmond ,
Andrew B. Goldstone  and
Eva W. Cheung Open the ORCID record for Eva W. Cheung [Opens in a new window]
Keriann L. Potter*
Affiliation:
Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Marc E. Richmond
Affiliation:
Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
Andrew B. Goldstone
Affiliation:
Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children’s Hospital NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
Eva W. Cheung
Affiliation:
Division of Pediatric Cardiology, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA Division of Pediatric Critical Care and Hospital Medicine, NewYork-Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York, NY, USA
*
Corresponding author: K. L. Potter; Email: kln2109@cumc.columbia.edu
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Abstract

Objectives:

This study investigated the association between early extubation (EE) and the degree of postoperative intensive care unit (ICU) support after the Fontan procedure, specifically evaluating the volume of postoperative intravenous fluid (IVF) and vasoactive-inotropic score (VIS).

Methods:

Retrospective analysis of patients who underwent Fontan palliation from 2008 to 2018 at a single center was completed. Patients were initially divided into pre-institutional initiative towards EE (control) and post-initiative (modern) cohorts. Differences between the cohorts were assessed using t-test, Wilcoxon, or chi-Square. Following stratification by early or late extubation, four groups were compared via ANOVA or Kruskal-Wallis Test.

Results:

There was a significant difference in the rate of EE between the control and modern cohorts (mean 42.6 versus 75.7%, p = 0.01). The modern cohort demonstrated lower median VIS (5 versus 8, p = 0.002), but higher total mean IVF (101±42 versus 82 ±27 cc/kg, p < 0.001) versus control cohort. Late extubated (LE) patients in the modern cohort had the highest VIS and IVF requirements. This group received 67% more IVF (140 ± 53 versus 84 ± 26 cc/kg, p < 0.001) and had a higher median VIS at 24 hours (10 (IQR, 5–10) versus 4 (IQR, 2–7), p < 0.001) versus all other groups. In comparison, all EE patients had a 5-point lower median VIS when compared to LE patients (3 versus 8, p= 0.001).

Conclusions:

EE following the Fontan procedure is associated with reduced post-operative VIS. LE patients in the modern cohort received more IVF, potentially identifying a high-risk subgroup of Fontan patients deserving of further investigation.

Keywords

Early extubationFontanintensive care unit utilization
Type
Original Article
Information
Cardiology in the Young , Volume 34 , Issue 2 , February 2024 , pp. 356 - 363
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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