No CrossRef data available.
Article contents
Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs
Published online by Cambridge University Press: 20 November 2023
Abstract
Backgrounds and Objectives:
The “Fast track” protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD.
Methods:
We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled “Fast track” protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays.
Results:
The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0–169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031).
Conclusions:
Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
- Type
- Original Article
- Information
- Copyright
- © The Author(s), 2023. Published by Cambridge University Press
References
Barash, PG, Lescovich, F, Katz, JD, Talner, NS, Stansel, HC Jr. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg 1980; 29: 228–233.CrossRefGoogle ScholarPubMed
Tirotta, CF, Alcos, S, Lagueruela, RG, et al. Three-year experience with immediate extubation in pediatric patients after congenital cardiac surgery. J Cardiothorac Surg 2020; 15: 1.CrossRefGoogle ScholarPubMed
Engelman, DT, Ben Ali, W, Williams, JB, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg 2019; 154: 755–766.CrossRefGoogle ScholarPubMed
Heard, GG, Lamberti, JJ Jr, Park, SM, Waldman, JD, Waldman, J. Early extubation after surgical repair of congenital heart disease. Crit Care Med 1985; 13: 830–832.10.1097/00003246-198510000-00010CrossRefGoogle ScholarPubMed
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; 25: 586–595.CrossRefGoogle ScholarPubMed
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: 865–871.10.1016/S0003-4975(99)01306-5CrossRefGoogle ScholarPubMed
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; 23: 348–357.CrossRefGoogle ScholarPubMed
Camp, SL, Stamou, SC, Stiegel, RM, et al. Quality improvement program increases early tracheal extubation rate and decreases pulmonary complications and resource utilization after cardiac surgery. J Card Surg 2009; 24: 414–423.10.1111/j.1540-8191.2008.00783.xCrossRefGoogle ScholarPubMed
Newburger, JW, Sleeper, LA, Bellinger, DC, et al. Pediatric heart network investigators. Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial. Circulation 2012; 125: 2081–2091.CrossRefGoogle ScholarPubMed
Varghese, J, Kutty, S, Bisselou Moukagna, KS, Craft, M, Abdullah, I, Hammel, JM. Five-year experience with immediate extubation after arterial switch operations for transposition of great arteries. Eur J Cardiothorac Surg 2017; 51: 728–734.CrossRefGoogle ScholarPubMed
Holowachuk, S, Zhang, W, Gandhi, SK, Anis, AH, Potts, JE, Harris, KC. Cost savings analysis of early extubation following congenital heart surgery. Pediatr Cardiol 2019; 40: 138–146.10.1007/s00246-018-1970-0CrossRefGoogle ScholarPubMed
Winch PD, Staudt AM, Sebastian, R, etal. Learning from experience: improving early tracheal extubation success after congenital cardiac surgery. Pediatr Crit Care Med 2016; 17: 630–637.10.1097/PCC.0000000000000789CrossRefGoogle Scholar
Gupta, P, McDonald, R, Goyal, S, et al. Extubation failure in infants with shunt-dependent pulmonary blood flow and univentricular physiology. Cardiol Young 2014; 24: 64–72.CrossRefGoogle ScholarPubMed
Mahle, WT, Jacobs, JP, Jacobs, ML, et al. Early extubation after repair of tetralogy of fallot and the fontan procedure: an analysis of the society of thoracic surgeons congenital heart surgery database. Ann Thorac Surg 2016; 102: 850–858.10.1016/j.athoracsur.2016.03.013CrossRefGoogle Scholar
Varghese, J, Hammel, JM, Ibrahimiye, AN, et al. Outcomes related to immediate extubation after stage 1 Norwood palliation for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 2019; 157: 1591–1598.CrossRefGoogle ScholarPubMed
Harris, KC, Holowachuk, S, Pitfield, S, et al. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg 2014; 148: 2642–2647.CrossRefGoogle ScholarPubMed
Hamilton, BC, Honjo, O, Alghamdi, AA, et al. Efficacy of evolving early-extubation strategy on early postoperative functional recovery in pediatric open-heart surgery: a matched case-control study. Semin Cardiothorac Vasc Anesth 2014; 18: 290–296.CrossRefGoogle ScholarPubMed
Kim, KM, Kwak, JG, Shin, BC, et al. Early experiences with ultra-fast-track extubation after surgery for congenital heart disease at a single center. Korean J Thorac Cardiovasc Surg 2018; 51: 247–253.10.5090/kjtcs.2018.51.4.247CrossRefGoogle ScholarPubMed
Kloth, RL, Baum, VC. Very early extubation in children after cardiac surgery*. Crit Care Med 2002; 30: 787–791.10.1097/00003246-200204000-00011CrossRefGoogle ScholarPubMed
Kim et al. supplementary material
Kim et al. supplementary material
File
15.2 KB