Early extubation in congenital heart surgery

Neirotti, Rodolfo A.; Jones, Donald H.; Hackbarth, Richard; Fosse, Gwen Paxson

doi:10.1046/j.1444-2892.2002.00144.x

Cited by 71 publications

(67 citation statements)

References 7 publications

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“…In our study, the extubation rate was comparable to those of previously reported results. [3][4][5][6]17) Down syndrome and patients who underwent palliative operation are frequently associated with increased perioperative morbidity, including air compromise and perfusion mismatch between arterial and venous circulation after surgery.…”

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

“…Similarly, other reports defined neonates as one of their exclusion criteria. [3][4][5]13,15) During the neonatal period, most operations were considered high risk (category 4-6) and included procedures such as repair of the total anomalous pulmonary venous return, the arterial switch operation, the Senning procedure, and truncus arteriosus repair. It is therefore understandable that many previous reports excluded neonates as candidates for early extubation.…”

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

“…In 1980, Barash and colleagues 1) reported their experiences with early extubation, and more recently, several studies have suggested that extubation can be performed safely in the operating room (OR) for simple and complex surgical cases in all age groups. [2][3][4] However, the success rate of early extubation in children has been variable and dependent on inclusion and exclusion criteria, such as the patient's age, case severity, and procedure complexity. 5,6) An analysis using the Risk Adjustment in Congenital Heart Surgery method (RACHS-1) revealed that success rate of early extubation became more variable in complex, high-risk cases, such as those with pulmonary hypertension, excessive pulmonary blood flow with a degenerative vascular bed, and/or single ventricular physiology.…”

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confidence: 99%

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Early Extubation in the Operating Room after Congenital Open-Heart Surgery

et al. 2018

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SummaryEarly extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.(Int Heart J 2018; 59: 94-98)

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Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

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confidence: 99%

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Early Extubation in the Operating Room after Congenital Open-Heart Surgery

et al. 2018

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“…Evidence to prove feasibility, safety, and costs associated with fast tracking in CHD surgery is mostly limited to single-center experiences. [3][4][5][6] No study to date has compared a cohort of infants and children undergoing surgery for CHD using an integrated fast-tracking strategy with a contemporaneous control cohort.…”

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confidence: 99%

Economic and Safety Implications of Introducing Fast Tracking in Congenital Heart Surgery

Lawrence

Nguyen

Morris

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background-The feasibility of fast-tracking children undergoing congenital heart disease surgery has not been assessed adequately. Current knowledge is based on limited single-center experiences without contemporaneous control groups. Methods and Results-We compared administrative data for atrial septal defect (ASD) and ventricular septal defect (VSD) surgeries in children 2 months to 19 years of age at the Mount Sinai Medical Center (MSMC) with data from comparable patients at 40 centers contributing to the Pediatric Health Information System. Three-year blocks, early in and after fast tracking had been implemented at the MSMC, were examined. Seventy-seven and 89 children at MSMC undergoing ASD and VSD closure, respectively, were compared with 3103 ASD and 4180 VSD patients nationally. With fast tracking fully implemented, median length of stay at the MSMC decreased by 1 day compared with the earlier era (length of stay, 1 and 3 days for ASD and VSD, respectively). Nationally, median length of stay remained unchanged (3 days for ASD and 4 days for VSD) in the observed time periods. Hospitalization costs fell by 33% and 35% at MSMC (ASD and VSD, respectively), whereas they rose by 16% to 17% nationally. When analyzed in multiple regression models, the decrease in both length of stay and cost remained significantly greater at MSMC compared with nationally (P<0.0001 for all). Hospital mortality and 2-week readmission rates were unchanged at MSMC between the 2 time periods and were not different from the national rates. Key Words: cardiac anesthesia ◼ mechanical ventilator ◼ pediatric cardiac surgery ◼ pediatric and congenital heart disease ◼ pediatric intensive care unit Conclusion-Shorter

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“…Study of the Neirotti et al (15) showed, as well as our research, that failure to thrive is one of the risk factor of prolonged ventilation [95%CI (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)]. …”

mentioning

confidence: 99%