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

Abstract

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)

Comparison of two cardiopulmonary bypass strategies with a miniaturized tubing system: a propensity score–based analysis

“…There are many predictors of successful early extubation, which includes preoperative factors such as age at operation, and intraoperative variables, especially the surgical procedure complexity. 27–30 Our results were consistent with previous studies. Redlin et al 31 reported a negative association on miniaturized CPB circuits with the time of ventilation in their study of low-priming-volume CPB in neonates with transposition of the great arteries.…”

Prognostic value of biomarkers after cardiopulmonary bypass in pediatrics: The prospective PANCAP study

“…Thus, early extubation of those patients would have to be carefully evaluated. In CPB, the classical parameters of early extubation have been surgical times, surgical difficulty and patients’ severity measured through risk scores such as PRISM III [41–45]. In our study, both parameters were higher in patients who required MV at admission than in those who did not.…”

The Impact of the Pulmonary Artery Index and Aortopulmonary Collateral Artery Coil Embolization on Intractable Pleural Effusions After a Fontan Surgery

“…In our practice, we try to extubate as soon as possible after Fontan operations, which is a feasible option, unless there is a risk of airway trouble. 12) Clinical implications of the influence of PAI on persistent pleural effusions: After Fontan operations, IVC flow is added to the bidirectional Glenn pulmonary circulation, and pulmonary blood flow (Qp) increases significantly. We speculate that if the pulmonary vascular bed (represented by PAI and pulmonary vascular compliance (Cp)) is not abundant enough to accommodate the added flow, then the "overflowed" Qp would emerge as a persistent pleural effusion.…”