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Factors affecting extubating time of postoperative patients who underwent congenital cardiac surgery: a randomized
1Department of Anesthesiology and Reanimation, Department of Cardiovascular Surgery, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey. mesut_kvc_cor@hotmail.com.
Insights
Factors like pre-existing conditions, airway difficulty, and longer cross-clamp times increase delayed mechanical ventilation (MV) weaning in pediatric cardiac surgery patients. Optimizing conditions allows for safe early extubation.
Area of Science:
- Anesthesiology
- Pediatric Cardiac Surgery
- Critical Care Medicine
Background:
- Anesthesia management in pediatric cardiac surgery aims to minimize morbidity and mortality.
- Postoperative mechanical ventilation (MV) duration significantly impacts recovery.
- Identifying factors influencing extubation time is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine factors associated with delayed extubation after pediatric cardiac surgery.
- To analyze predictors of prolonged mechanical ventilation in this patient population.
Main Methods:
- A retrospective study included 72 pediatric patients (ASA score III or above) undergoing cardiac surgery.
- Patients were categorized into Immediate Extubators (OR), Early Extubators (6-48 hours in ICU), and Delayed Extubators (>48 hours or not extubated).
- Logistic regression analysis was used to identify influencing factors.
Main Results:
- Anomalies, preoperative MV requirement, airway difficulty, and prolonged cross-clamp (CC) time were significant predictors of delayed extubation (DE).
- The risk of DE was substantially increased by the presence of abnormalities (OR: 20.3), preoperative MV (OR: 1,844), and airway difficulty (OR: 44.7).
- Each additional minute of CC time increased the probability of DE by 1.038 (95% CI: 1.004-1.072).
Conclusions:
- Early and immediate extubation is feasible and safe in pediatric cardiac surgery patients.
- Careful patient selection and optimization of conditions are key to successful early extubation.
- Understanding predictors of delayed extubation can guide anesthetic management and postoperative care strategies.
Objective:
Anesthesia management in pediatric cardiac surgery using health resources sparingly focuses on reducing morbidity and mortality and increasing patients' quality of life. The duration of postoperative mechanical ventilation (MV) heavily influences pediatric cardiac surgery recovery. Thus, in this study we aimed to determine factors influencing extubation times after pediatric cardiac surgery.
Patients And Methods:
A total of 72 pediatric patients with an ASA score of III or above undergoing cardiac surgery were included in the study. As a result of their extubation time, the patients were divided into three groups as follows: those who were extubated immediately after surgery or in the operating room (OR) were recorded as Immediate Extubators (IE); those who were extubated within 6 to 48 hours of entering the intensive care unit were recorded as Early Extubators (EE), and those who were extubated after 48 hours or not extubated were recorded as Delayed Extubators (DE).
Results:
A logistic regression analysis showed that anomalies and need of MV before surgery, airway difficulty, and prolonged cross-clamp (CC) time were observed as factors affecting DE. The risk of DE was significantly correlated with the presence of abnormality [Odds ratio (OR): 20.3, 95% Confident interval (CI): 2.8-142.7], with the need of MV before surgery (OR: 1,844, 95% CI: 1.8-1,790,461.9), and with the presence of airway difficulty (OR: 44.7, 95% CI: 4.4-445.0). In addition, it was determined that CC time increased the probability of DE 1.038 times per minute (95% CI: 1.004-1.072).
Conclusions:
Early and immediate extubation in children who underwent congenital heart surgery was successfully performed in our clinic. Early and immediate extubation in pediatric cardiac surgery can be completed safely and successfully when suitable conditions are provided.
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