Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Ödek, Çağlar; Kendirli, Tanıl; Uçar, Tayfun; Yaman, Ayhan; Tutar, Ercan; Eyileten, Zeynep; Taşar, Mehmet; Ramoğlu, Mehmet Gökhan; Ateş, Can; Uysalel, Adnan; İnce, Erdal; Atalay, Semra

doi:10.1007/s00246-016-1423-6

Cited by 26 publications

(24 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[ 22 ] Complexity of the procedure has been shown to affect the outcome after pediatric cardiac surgery. [ 14 18 23 ] Ödek et al . found RACHS-1 category procedure to be associated with early extubation.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Szekely et al 8 compared a lower RACHS-1 score (groups 1-3) with a higher RACHS-1 score (groups 4-6) and found a correlation between higher RACHS-1 score and a medium (>61 hours) and long (>7 days) ventilation time. Likewise, Odek et al 11 found a correlation between low RACHS-1 score and early extubation, though they included only RACHS-1 groups 1-3. The already mentioned Japanese study 9 is the only other study that describes the postoperative ventilation time in relation to the RACHS-1 score.…”

Section: Discussionmentioning

confidence: 99%

RACHS-1 score as predictive factor for postoperative ventilation time in children with congenital heart disease

et al. 2020

View full text Add to dashboard Cite

AbstractBackground:Congenital heart disease is the most frequent malformation in newborns. The postoperative mortality of these patients can be assessed with the Risk Adjustment in Congenital Heart Surgery-1 (RACHS-1) score. This study evaluates whether the RACHS-1 score can also be used as a predictor for the length of postoperative ventilation and what is the influence of age.Material and Methods:In a retrospective study over the period from 2007 to 2013, all patient records were evaluated: 598 children with congenital heart disease and cardiac surgery were identified and 39 patients have been excluded because of additional comorbidities. For evaluation of mortality, 559 patients could be analysed, after exclusion of 39 deceased patients, 520 cases remained for analysis of postoperative ventilation.Results:Overall mortality was 7% with a dependency on RACHS-1 categories. The median length of postoperative ventilation rose according to the RACHS-1 categories: RACHS-1 category 1: 9 hours (interquartile range (IQR) 7–13 hours), category 2: 30 hours (IQR 12–85 hours), category 4: 58 hours (IQR 13–135 hours), category 4: 71 hours (IQR 29–165 hours), and category 6: 189 hours (IQR 127–277 hours). Some of the RACHS-1 subgroups differed significantly from the categories, especially the repair of tetralogy of Fallot with a longer ventilation time and strong variability. Younger age was an independent factor for longer postoperative ventilation.Conclusion:RACHS-1 is a good predictor for the length of postoperative ventilation after cardiac surgery with the exception of some subgroups. Younger age is another independent factor for longer postoperative ventilation. These data provide better insight into ventilation times and allow better planning of operations in terms of available intensive care beds.

show abstract

“…Early extubation is associated with low morbidity rates and short ICU LOS in patients undergoing surgery for CHD. Most can be extubated in the operating room and most neonates undergoing surgery for complex CHD can be extubated in the first 24 hours after surgery [17] [18] [19]. Younger age, lower weight, heart failure, higher VIS, pulmonary hypertension, delayed sternal closure, greater severity of illness at post-operative admission, BUN, nitric oxide treatment, tracheobronchomalacia, peritoneal dialysis, low cardiac output, health-care associated infections, and noninfectious pulmonary complications are associated with prolonged intubation in patients undergoing surgery for CHD [20] [21] [22] [23].…”

Section: L Mahan Et Al World Journal Of Cardiovascular Surgerymentioning

confidence: 99%

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

Mahan¹,

Gupta²,

Aronoff³

et al. 2018

WJCS

View full text Add to dashboard Cite

Background: The vasoactive-ventilation-renal (VVR) score includes pulmonary and renal dysfunctions not previously addressed by the vasoactive inotrope score (VIS) and may be a better predictor of cardiac care unit (CCU) length of stay (LOS) in patients undergoing re-entry sternotomy (defined as no earlier than 30 days after previous sternotomy) for congenital heart disease (CHD). Methods: Patients undergoing re-entry sternotomy for CHD from August 1, 2009 to June 30, 2016 were studied retrospectively. A total of 96 patients undergoing 133 re-entry procedures were identified. VVR scores were calculated on CCU admission post-procedure (at 0 hour), 24-hour, and 48-hour after admission to the CCU. The response variable was CCU LOS. Recursive partition analysis identified variables predicting LOS. Results: 133 re-entry sternotomies in 96 patients made up the samples of the database; 11 samples were removed due to incomplete data or placement on ECMO. Of the initial 25 features, 5 were removed for near zero variance and 3 categorical features were removed for non-information. Covariance analysis did not demonstrate any significant correlation amongst the remaining features. Initial recursive tree regression using ANOVA, cross validation and conditional predictive p-value (cp) = 0.01 produced 3 trees. The tree with lowest cross validation error was selected. The resulting 2 split trees with ventilator days less

show abstract

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Cited by 26 publications

References 34 publications

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

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

RACHS-1 score as predictive factor for postoperative ventilation time in children with congenital heart disease

Vasoactive-Ventilation-Renal Score Predicts Cardiac Care Unit Length of Stay in Patients Undergoing Re-Entry Sternotomy: A Derivation Study

Contact Info

Product

Resources

About