Related Experiment Video
Updated: Jul 16, 2025
Insertion, Maintenance, and Removal of the Percutaneous Dual Lumen Cannula Right Ventricular Assist Device
Published on: July 20, 2022
Risk factors associated with prolonged intensive care unit stay following surgery for total anomalous pulmonary
Jinjin Huang1, Jian Tang1, Yong Fan2
1Department of Anesthesiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Lower preoperative oxygen saturation, higher intraoperative lactate, and prolonged mechanical ventilation are key risk factors for extended intensive care unit stays in children undergoing total anomalous pulmonary venous connection repair. Optimizing these factors can improve outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Intensive Care Medicine
- Congenital Heart Disease Research
Background:
- Prolonged intensive care unit (ICU) stays in pediatric patients increase healthcare costs and resource utilization.
- Total anomalous pulmonary venous connection (TAPVC) repair is a complex procedure with potential for extended ICU stays.
- Identifying risk factors for prolonged ICU stay after TAPVC repair is crucial for optimizing patient management.
Purpose of the Study:
- To identify independent risk factors associated with prolonged postoperative ICU stay in pediatric patients undergoing surgical repair of TAPVC.
- To establish specific thresholds for identified risk factors that correlate with increased ICU stay duration.
- To inform clinical strategies aimed at reducing ICU length of stay in this patient population.
Main Methods:
- Retrospective analysis of medical records from 85 pediatric patients who underwent TAPVC surgical repair.
- Classification of patients into prolonged-stay (exceeding 75th percentile) and standard-stay groups based on ICU duration.
- Univariate and logistic regression analyses to determine the impact of patient variables on ICU stay.
Main Results:
- Lower preoperative pulse oximetry saturation (SpO2 < 88.5%), higher intraoperative plasma lactate levels (> 4.15 mmol/L), and prolonged postoperative mechanical ventilation (> 53.5 hours) were identified as independent risk factors for prolonged ICU stay.
- Other potential contributing factors included young age, low body weight, subcardiac TAPVC type, need for vasoactive drugs, emergency surgery, long anesthesia and cardiopulmonary bypass times, low temperature, significant ultrafiltration, large drainage volumes, extensive blood product transfusion, and postoperative cardiac dysfunction.
- The prolonged-stay group (n=23) had ICU durations of 11-68 days, compared to 2-10 days for the standard-stay group (n=62).
Conclusions:
- Preoperative SpO2, intraoperative lactate levels, and duration of postoperative mechanical ventilation are critical predictors of prolonged ICU stay in pediatric TAPVC patients.
- Specific thresholds for these factors (SpO2 < 88.5%, lactate > 4.15 mmol/L, ventilation > 53.5 hours) significantly increase the risk of extended ICU admission.
- Enhanced clinical management, focusing on early diagnosis, timely surgical intervention to mitigate hypoxia, and preserving intraoperative cardiac function, may effectively reduce ICU length of stay.
Background:
Prolonged intensive care unit (ICU) stays consume medical resources and increase medical costs. This study identified risk factors associated with prolonged postoperative intensive care unit (ICU) stay in children with total anomalous pulmonary venous connection (TAPVC).
Methods:
The medical records of 85 patients who underwent surgical repair of TAPVC were retrospectively analyzed. The patients were divided into prolonged-stay and standard-stay groups. The prolonged stay group included all patients who exceeded the 75th percentile of the ICU stay duration, and the standard stay group included all remaining patients. The effects of patient variables on ICU stay duration were investigated using univariate and logistic regression analyses.
Results:
Patient median age was 41 (18-103) days, and median weight was 3.80 (3.30-5.35) kg.Postoperative duration of ICU stay was 11-68 days in the prolonged stay group (n = 23) and 2-10 days in the standard stay group (n = 62). Lower preoperative pulse oximetry saturation (SpO2), higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay. Preoperative SpO2 < 88.5%, highest plasma lactate value > 4.15 mmol/L, and postoperative mechanical ventilation duration was longer than 53.5 h, were associated with increased risk of prolonged ICU stay. Young age, low body weight, subcardiac type, need for vasoactive drug support, emergency surgery, long anesthesia time, low SpO2 after anesthesia induction, long cardiopulmonary bypass (CPB) and aortic clamp times, high lactate level, low temperature, large volume of ultrafiltration during CPB, large amounts of chest drainage, large red blood cells (RBCs) and plasma transfusion, and postoperative cardiac dysfunction may be associated with prolonged ICU stay.
Conclusions:
Lower preoperative SpO2, higher intraoperative plasma lactate levels, and prolonged postoperative mechanical ventilation were independent risk factors for prolonged ICU stay in children with TAPVC. When SpO2 was lower than 88.5%, the highest plasma lactate value was more than 4.15 mmol/L, and the postoperative mechanical ventilator duration was longer than 53.5 h, the risk of prolonged ICU stay increased. Improved clinical management, including early diagnosis and timely surgical intervention to reduce hypoxia time and protect intraoperative cardiac function, may reduce ICU stay time.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:22Aneurysm IV: Nursing Management
01:30Venous Thrombosis I: Introduction
01:21Cardiac Catheterization II: Right Heart Catheterization
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...