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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

Chan Hyeong Kim
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Jae Hong Lee
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Hye Won Kwon
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Sungkyu Cho
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Woong-Han Kim
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Sang-Hwan Ji
Affiliation:
Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
Young-Eun Jang
Affiliation:
Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
Jin-Tae Kim
Affiliation:
Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
Jae Gun Kwak*
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
*
Corresponding author: J. G. Kwak; Email: switch.surgeon@gmail.com

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
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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