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Extubation in the operating room after congenital heart surgery in children
Alexander J C Mittnacht1, Maria Thanjan, Shubhika Srivastava
1Department of Anesthesiology, Mount Sinai Medical Center, New York, NY 10029, USA. alexander.mittnacht@msnyuhealth.org
Insights
Early extubation in the operating room is successful for most children undergoing congenital heart surgery. Younger age and longer cardiopulmonary bypass times are key factors predicting the need for continued mechanical ventilation.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Anesthesiology
Background:
- Early extubation in the operating room (OR) after congenital heart defect (CHD) surgery is an emerging strategy.
- Postoperative mechanical ventilation in the intensive care unit (ICU) remains standard practice in many centers.
- Identifying factors influencing OR extubation success is crucial for optimizing patient care.
Purpose of the Study:
- To determine perioperative factors associated with failure to extubate in the operating room after CHD surgery.
- To evaluate the feasibility of early extubation in a pediatric cardiac surgery population.
Main Methods:
- Retrospective chart review of 224 pediatric patients (1 month to 18 years) undergoing cardiopulmonary bypass for CHD repair.
- Exclusion of preoperatively ventilated patients.
- Stepwise logistic regression analysis to identify independent predictors of OR extubation.
Main Results:
- 79% of patients were successfully extubated in the operating room.
- Younger age (each younger age group decreased OR extubation chance by 56%) and longer cardiopulmonary bypass (CPB) time (>150 minutes increased risk 11.8-fold) were the strongest predictors against OR extubation.
- Male gender and high post-CPB inotropic support also correlated with lower OR extubation rates.
Conclusions:
- Operating room extubation is a successful strategy for the majority of pediatric patients after CHD surgery.
- Younger age and prolonged cardiopulmonary bypass time are significant independent risk factors for failing to extubate in the operating room.
- These findings can help guide clinical decision-making regarding planned extubation in this population.
Objective:
Early extubation in the operating room after surgery for congenital heart disease has been described; however, postoperative mechanical ventilation in the intensive care unit remains common practice in many institutions. The goal of this study was to identify perioperative factors associated with not proceeding with planned operating room extubation.
Methods:
We performed a retrospective chart review of 224 patients (aged 1 month to 18 years, median 20 months) undergoing surgery for congenital heart defects requiring cardiopulmonary bypass. Patients mechanically ventilated preoperatively were excluded. A stepwise logistic regression model was used to test for the independent influence of various perioperative factors on extubation in the operating room.
Results:
Overall, 79% of patients were extubated in the operating room. Younger age and longer cardiopulmonary bypass time were the strongest predictors for not extubating. Each step down to a younger age group (<2, 2-4, 4-6, 6-12, >12 months) reduced the chance of extubation in the operating room by 56%. Cardiopulmonary bypass time for more than 150 minutes was associated with an 11.8-fold increased risk of not being extubated. Male gender and high inotrope requirement after cardiopulmonary bypass were also significantly associated with fewer children being extubated.
Conclusion:
Extubation in the operating room after surgery for congenital heart disease was successful in the majority of patients. The strongest independent risk factors for failure of this strategy included younger age and longer cardiopulmonary bypass time.
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