Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery

Székely, Andrea; Sápi, Erzsébet; Király, László; Szatmári, András; Dinya, Elek

doi:10.1111/j.1460-9592.2006.01957.x

Cited by 108 publications

(127 citation statements)

References 25 publications

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“…1,3,14) A long CPB time was consistently associated with prolonged mechanical ventilation and serious bleeding after open-heart surgery. In addition, this was associated with an increased risk of inflammatory response syndrome and cardiac edema, resulting in delayed sternal closure, decreased respiratory compliance, acute lung injury, and coagulopathy or serious bleeding.…”

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

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%

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

et al. 2018

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“…The analysis of the progression of the children with and without respiratory complications showed that these postoperative complications determine a longer mechanical ventilation time and hospitalization, factors that are known to affect surgical success. However, after seven days on mechanical ventilation, it is difficult to differentiate complications that are secondary to heart disease from those caused by the need to receive prolonged ventilation support (16) , such as pneumonia. The different diagnoses and surgical techniques used, as well as the therapies chosen for the postoperative care, make this analysis difficult, and it is not possible to assign a causal relation to respiratory complications.…”

Section: Discussionmentioning

confidence: 99%

“…In international studies, Székely et al (16) evaluated a group of 411 children that underwent heart surgery and found a mortality rate of 3.2%. However, those authors stress that 15 of those children were transferred to other medical services and two died after hospital discharge.…”

Section: Discussionmentioning

confidence: 99%

Perfil das crianças submetidas à correção de cardiopatia congênita e análise das complicações respiratórias

Oliveira

Held

Grande

et al. 2012

Rev. paul. pediatr.

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6Doutora em Saúde da Criança e do Adolescente pela Unicamp, Campinas, SP, Brasil; Professora efetiva do curso de graduação e pós-graduação em Fisioterapia da Udesc, Florianópolis, SC, Brasil ABSTRACTObjective: To describe the profile of children that undergo surgical correction of congenital heart disease (CHD) in a university hospital and to compare patients with and without postoperative respiratory complications.Method: This observational analytical study reviewed the records of children that underwent corrective surgery for CHD a Brazilian University Hospital during 11 months. The following demographic variables were collected: age, sex, body mass index, comorbidities, and CHD types. Demographic variables and data about the intra-and postoperative care were compared for patients with and without postoperative respiratory complications. The Mann-Whitney and the Fisher exact tests were used, and the level of significance was set at p<0.05.Results: The sample consisted of 55 children (49% boys) whose median age was 37.5 months. Three or more CHD were found in 29.1%, and 53% of all cases had comorbidities. The analysis of postoperative respiratory complications revealed that 31% of the patients had atelectasis and pleural effusion and 5.5% had laryngitis, pneumomediastinum or lung injury. Non-respiratory complications were identified in 24% of the patients. Survival was 89%. Children with postoperative respiratory complications received mechanical ventilation for a longer time and had a prolonged hospital stay (p<0.001). Conclusion:The association between respiratory complications, longer mechanical ventilation and longer hospital stay reinforced the need to avoid such complications to reduce costs of a prolonged hospital stay.Key-words: heart defects, congenital; thoracic surgery; clinical evolution; intensive care units; pediatrics. Resultados: Foram analisados 55 (95%) prontuários disponíveis de crianças submetidas à cirurgia cardíaca com mediana de idade de 37,5 meses, sendo 49% meninos. Presença de três ou mais CC foi verificada em 29,1% dos pacientes e 53% dos casos apresentavam comorbidades. Quanto às complicações respiratórias no pós-operatório, 31% dos pacientes evoluíram com atelectasia/derrame pleural e 5,5% laringite/pneumomediastino/lesão pulmonar. Complicações em outros sistemas foram identificadas em 24% dos pacientes. A sobrevida foi de 89% e crianças com complicações respiratórias no pós-operatório foram submetidas a maior tempo de ventilação mecânica e permanência hospitalar (p<0,001).Conclusões: O conhecimento da relação entre complicações respiratórias e maior tempo de ventilação mecânica e hospitalização reforça a necessidade de prevenir tais complicações para redução dos custos hospitalares.Palavras-chave: cardiopatias congênitas; cirurgia torácica; evolução clínica; unidade de terapia intensiva; pediatria. RESUMENObjetivo: Describir las características demográficas y clínicas de niños sometidos a la cirugía de corrección de cardiopatía congénita (CC) en un hospital universitario, comparand...

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“…Studies have reported mixed findings regarding the association of higher fluid intake volumes and longer duration of mechanical ventilation Szekely et al, 2006 .…”

Section: Fluid Intake Volume and Postoperative Outcomesmentioning

confidence: 99%

“…A limited number of studies have evaluated fluid intake in infants with congenital heart defects who are recovering from cardiac surgery Szekely, Sapi, Kiraly, Szatmari, & Dinya, 2006). identified fluid restriction as the major barrier to providing adequate nutrition, with fluid restriction defined as less than 80% of daily maintenance fluid requirements.…”

Section: Postoperative Fluid Volumes In Clinical Practicementioning

confidence: 99%

Defining Fluid Restriction in the Management of Infants Following Cardiac Surgery and Understanding the Subsequent Impact on Nutrient Delivery and Growth Outcomes

Li¹

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Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery

Abstract: Causes of MV after surgery are heterogeneous, vary with time, and have variable impact on the duration of MV.

Cited by 108 publications

References 25 publications

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

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

Perfil das crianças submetidas à correção de cardiopatia congênita e análise das complicações respiratórias

Defining Fluid Restriction in the Management of Infants Following Cardiac Surgery and Understanding the Subsequent Impact on Nutrient Delivery and Growth Outcomes

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