Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study

Abstract

Objective:The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort.Materials and Methods:This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis.Results:One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation.Conclusion:Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.

Influence of Early Extubation Location on Outcomes Following Pediatric Cardiac Surgery*

“…We defined early extubation as extubation in the OR or CICU within 6 hours of postoperative admission, consistent with previous literature (15,16). Patient characteristics analyzed included age, prematurity, gender, weight status at surgery, race, ethnicity, chromosomal/syndromic or genetic anomaly, and airway anomaly.…”

A Quality Initiative for Reducing Postoperative Hypothermia for Neonatal Intensive Care Unit Surgical Patients

“…Also, while not part of a deliberate quality improvement effort, this variation may also reflect changes in clinical practice to reduce the length of intubation and subsequently reduce the risk of ventilator-associated pneumonia, intensive care unit stay, and hospital stay as per recently published outcomes. 21 – 23 …”

Early Extubation in Children after Cardiac Surgery. Initial Experience from a Tertiary Care Hospital in Mexico City

“…However, all the remaining complications, except deaths, were more frequent with DD, something similar that was reported in other studies. 12,13 Lastly, the duration of mechanical ventilation, length of intensive care, and length of hospital stay were significantly shorter with EE. Similar results have been reported, which show that EE has a very favorable impact by reducing the time required in the care of these children.…”

“…Similar results have been reported, which show that EE has a very favorable impact by reducing the time required in the care of these children. 7,8,13,14 Factors Associated with Prolonged Mechanical Ventilation…”