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Early extubation after cardiac operations in neonates and young infants
J S Heinle1, L K Diaz, L S Fox
1Cook Children's Medical Center, Fort Worth, Tex 76104, USA.
Insights
Early extubation after congenital heart surgery is feasible for neonates and infants, leading to shorter hospital stays and reduced costs. This approach is safe and beneficial for improving patient outcomes.
Area of Science:
- Pediatric Cardiac Surgery
- Neonatal Intensive Care
- Cardiovascular Anesthesiology
Background:
- Congenital heart defects necessitate surgical intervention in neonates and infants.
- Postoperative mechanical ventilation is a standard but resource-intensive component of care.
- Optimizing ventilation strategies can improve patient outcomes and reduce healthcare costs.
Purpose of the Study:
- To assess the feasibility and safety of early extubation in neonates and young infants following surgical repair of congenital heart lesions.
- To evaluate the impact of early extubation on hospital resource utilization and associated costs.
Main Methods:
- Retrospective review of medical records for patients under 90 days of age undergoing cardiac operations over a one-year period.
- All patients were managed as candidates for early extubation.
- Data collected included patient demographics, extubation timing, reintubation rates, and clinical outcomes.
Main Results:
- 50% of patients (28/56) were extubated in the operating room or within 3 hours of ICU arrival.
- Early extubation was associated with significantly shorter intensive care unit (ICU) and hospital stays.
- Patients undergoing early extubation incurred lower ICU and total hospital costs compared to those requiring prolonged ventilation.
Conclusions:
- Early extubation is a safe and achievable strategy for a significant proportion of neonates and young infants after congenital heart surgery.
- Implementing early extubation protocols can lead to substantial reductions in hospital length of stay and healthcare expenditures.
- This approach offers a promising avenue for improving efficiency in pediatric cardiac surgical care.
Objective:
This study was undertaken to determine the feasibility of early extubation of the neonate and young infant after surgical repair of congenital heart lesions.
Methods:
The records of all patients less than 90 days of age who had cardiac operations over a 1-year period were reviewed. During this time, all patients were managed as potential candidates for early extubation. Fifty-six patients are included with a mean age of 32 +/- 31 days and a mean weight of 3.7 +/- 0.9 kg.
Results:
Twenty-eight patients (50%) were extubated in the operating room or within 3 hours after arriving in the intensive care unit. This included 38% of patients less than 7 days of age, 50% of patients 8 to 30 days of age, 44% of patients 31 to 60 days of age, and 69% of patients 61 to 90 days of age. Three patients (11%) extubated early required reintubation. No deaths were related to early extubation. Only one patient was negatively affected by early extubation. Patients extubated early had shorter stays in the intensive care unit (3.3 +/- 3.9 vs 6.7 +/- 2.9 days) and shorter postoperative hospital stays (5.9 +/- 3.3 vs 13.5 +/- 9.7 days), as well as lower intensive care unit ($5,851 +/- $7,225 vs $12,064 +/- $4,419) and total hospital ($21,108 +/- $14,941 vs $31,608 +/- $9,861) costs than patients who were ventilated.
Conclusions:
Early extubation can be accomplished safely in many neonates and young infants undergoing cardiac operations for repair of congenital heart defects and can shorten hospital stay and reduce costs.