Early Versus Late Extubation in Pediatric Cardiac Surgery: A Systematic Review

Area of Science:

• Pediatric Cardiac Surgery
• Critical Care Medicine
• Systematic Review and Meta-Analysis

Background:

• Early extubation (EE) and immediate extubation (IE) are emerging strategies in pediatric cardiac surgery.
• These approaches aim to reduce hospital and intensive care unit (ICU) stays and postoperative complications.
• Congenital heart disease surgery in children presents unique challenges for extubation timing.

Purpose of the Study:

• To systematically review and assess the outcomes of EE and IE compared to traditional delayed extubation (DE).
• To evaluate the impact of extubation strategies on ICU length of stay, hospital stay, reintubation rates, and mortality.
• To synthesize evidence from recent studies (2014-2023) on extubation timing in pediatric cardiac surgery.

Main Methods:

• Systematic review conducted following PRISMA guidelines.
• Literature search of PubMed, Web of Science, and CENTRAL databases for studies published between 2014 and 2023.
• Quality assessment of 22 included studies (8359 patients) using the Newcastle-Ottawa scale.

Main Results:

• Higher reintubation rates were reported in some EE (6 studies) and IE (2 studies) compared to DE.
• Shorter ICU stays were observed in 7 EE and 7 IE studies versus DE.
• Shorter hospital stays were found in 5 EE and 6 IE studies compared to DE.
• Increased mortality was noted in 2 EE studies versus DE.

Conclusions:

• EE can be advantageous in selective pediatric cardiac surgery patients, leading to quicker recovery and reduced resource utilization.
• Variability in outcomes highlights the need for standardized procedures and careful patient selection.
• Further prospective research is essential to optimize extubation strategies and patient outcomes.