Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Odek Ç., Kendirli T., Ucar T., Yaman A., Tutar E., Eyileten Z., ...More

PEDIATRIC CARDIOLOGY, vol.37, no.7, pp.1241-1249, 2016 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 37 Issue: 7
  • Publication Date: 2016
  • Doi Number: 10.1007/s00246-016-1423-6
  • Journal Name: PEDIATRIC CARDIOLOGY
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.1241-1249
  • Keywords: Cardiac surgery, Congenital heart disease, Delayed extubation, Early extubation, Mechanical ventilation, Pediatric, PROLONGED MECHANICAL VENTILATION, CONGENITAL HEART-SURGERY, RISK-FACTORS, PREVENTION, MORTALITY, CHILDREN, EFFICACY, FAILURE, REINTUBATION, INFANTS
  • Bursa Uludag University Affiliated: No

Abstract

This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (< 24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (p = .009), greater body weight (p = .009), absence of preoperative pulmonary hypertension (p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass (p = .008) and cross-clamp (p = .022) times, lower PRISM III-24 (p < .05) and PELOD (p < .05) scores, lower inotropic score (p < .05) and vasoactive-inotropic score (p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.