Ventilatory weaning strategies for predicting extubation success in children following cardiac surgery for congenital heart disease: a protocol for a systematic review and meta-analysis

Abstract

IntroductionCongenital heart disease (CHD) comprises the anatomic malformations that jeopardise the structure and function of the heart. It can be extremely complex and serious, corresponding to 30% of all deaths in the first month of life. The surgical approach for adequate treatment requires postoperative mechanical ventilation. The most critical decision related to the postoperative management of patients submitted to cardiac surgery is the right time for extubation, especially because not only abrupt or inadequate discontinuation of ventilatory support can lead to clinical decline and necessity of reintubation but also extended time of mechanical ventilation, which can lead to complications, such as pneumonia, atelectasis, diaphragm hypertrophy, and increasing morbidity and mortality.Methods and analysisThis systematic review plans to include individual parallel, cross-over and cluster randomised controlled trials regarding any breathing trial test to predict extubation success in children submitted to cardiac surgery due to CHD. Studies with paediatric patients submitted to cardiac surgery for congenital cardiopathy repair, attended at a critical care unit, and under mechanical ventilatory support will be included. The main outcomes analysed will be success of extubation, reduction of pulmonary complications and time reduction of mechanical ventilation.Ethics and disseminationWe will not treat patients directly; therefore, ethics committee approval was not necessary because it is not a primary study. We expect that this study may improve healthcare and medical assistance, helping healthcare professionals with routine daily decisions regarding the correct time for extubation.PROSPERO registration numberCRD42021223999.

Clinical Challenges in Pediatric Ventilation Liberation: A Meta-Narrative Review

“…These include age, nutritional status, neurologic functioning, Pediatric Risk of Mortality score, mean airway pressure, oxygenation index, spontaneous respiratory rate, and hemodynamic status (7,12,28,42,45,46,48,(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68). Limited studies have been performed in pediatric cardiac patients (69). This group of patients might be studied separately as extubation failure in these patients underlying cardiac dysfunction can be unmasked during ventilator weaning, although the concept and approach to ventilation liberation may in fact not be different from noncardiac patients (70,71).…”