Predictors of Successful Early Extubation Following Congenital Cardiac Surgery in Neonates and Infants

Winch, Peter D.; Nicholson, Lisa; Isaacs, Janet Sugarman; Spanos, Steven; Olshove, Vincent; Naguib, Aymen

doi:10.1016/j.hlc.2008.11.009

Cited by 30 publications

(23 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

et al. 2018

View full text Add to dashboard Cite

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)

show abstract

Section: Extubation In or After Congenital Heart Surgerymentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Many authors have described successful algorithms for selecting candidates for early extubation(6, 9, 14, 16, 17). Unfortunately, across published reports, the definition of early exutabtion has not been consistent.…”

Section: Discussionmentioning

confidence: 99%

Early extubation in pediatric heart surgery across a spectrum of case complexity: Impact on hospital length of stay and chest tube days

Beamer

Ferns²,

Edwards

et al. 2017

Progress in Pediatric Cardiology

View full text Add to dashboard Cite

Unstructured abstract Early extubation is increasingly common in congenital heart surgery, but there are limited outcomes data across the spectrum of case complexity. We performed a retrospective review of 201 pediatric operations using cardiopulmonary bypass between 2012 and 2014. Patients extubated in the operating room or immediately on arrival to the ICU were compared to those extubated by traditional protocols. In-hospital mortality, major complications, need for re-intubation, hospital length of stay, and chest-tube days were compared between groups and by Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery Congenital Heart Surgery (STAT) mortality category. Outcome measures of hospital length of stay and chest tube days were analyzed using multivariable regression modeling. Early extubation subjects were older, weighed more, had shorter bypass and aortic cross-clamp time, more often received caudal anesthesia, and had shorter hospital length of stay and fewer chest tube days. Subjects not extubated early had more chromosomal abnormalities, more preoperative co-morbidities, and had more major complications. Inhospital death, major complications, and re-intubation were rare outcomes for both groups across all STAT categories. Multivariable regression analysis showed that cardiopulmonary bypass time was a significant predictor of hospital length of stay and chest tube days. Hospital LOS and chest tube days were significantly lower for the early extubation group in both the unadjusted and adjusted analyses. Early extubation can be performed safely in congenital heart surgery across a spectrum of case complexity. No increased early mortality or re-intubation was observed with early extubation although there were important differences between the groups that merits further study. The potential benefits of early extubation include decreased hospital length of stay and fewer chest tube days, particularly in young children and patients with long bypass times.

show abstract

“…

Early Extubation Following Cardiac Surgery in Neonates and InfantsW e read with great interest the paper by Winch et al [1]. However, we do not agree with their bold approach concerning immediate extubation in neonates and infants following cardiac surgery.

…”

mentioning

confidence: 85%

“…in critique of our article [1]. The practice of extubating neonates and children immediately following cardiac surgery has been previously discussed in the literature and is not unique to our institution [2].…”

Section: Reply: Early Extubation Following Cardiac Surgery In Neonatementioning

confidence: 99%