Tirotta CF, et al. J Cardiothorac Surg. 2020 Jan 6;15(1):1.
Tirotta CF, et al., conducted a study to verify that Immediate Extubation (IE) can be carried out securely in pediatric patients following congenital cardiac surgery with enhanced patient outcomes.
For pediatric patients who are experiencing cardiac surgery with cardiopulmonary bypass, almost 637 consecutive patient charts were reviewed. Into 3 groups, patients were classified as (1) extubated in the operating room (OR) at the conclusion of surgery (IE), (2) extubated during six hours of admission to the ICU (Early Extubation or EE) and (3) extubated short time later six hours (Delayed Extubation or DE). To observe which factors are associated with successful IE or EE, numerous parameters were registered.
Generally, 338 patients (53.1%) had IE, 273 (42.8%) had DE whereas only 26 patients (4.1%) had EE. The median age for IE, DE and EE patients was 1174 days, 39 days, and 194 days (p < 0.001). Significant difference was observed in weight and length in at least one extubation group from the other two (p < 0.001). For IE and EE patients, the median intensive care unit length of stay (ICU LOS) was 3 and 4 days, while for DE patients it was 9.5 days (p < 0.001), respectively. Significant longer median anesthesia time and cardiopulmonary bypass (CPB) time was observed in DE group as compared to the other two extubation groups, p < 0.001 (Table 1). Significant correlation was observed between regional low flow (RLF), deep hypothermia, deep hypothermic circulatory arrest (DHCA), redo, use of other sedatives, lasix, epinephrine, vasopressin, open chest, cardiopulmonary support (CPS), pulmonary edema, syndrome, as well as difficult intubation with extubation time (IE, EE or DE) (Table 2, p < 0.05). Low temperature, urine output, doses of fentanyl, midazolam, rocuronium, human fibrinogen concentrate (HFC), milrinone, epinephrine, and intensive care unit estimated blood loss (ICU EBL), adjusting for patient’s age, weight and length were significantly correlated with extubation group (Table 3, p < 0.05). Generally, out of 637 patients, 350 (54.9%) patients were infants. Of the 350 patients, 232 (66.3%) had DE, 103 (29.4%) had IE, and 14 (4.3%) had EE. The median age for DE, IE and EE patients was 20 days, 174 days, and 157 days (p < 0.0001). Significant difference was observed in weight and length in at least one extubation group from the other two (p < 0.0001). Patients who efficiently undergo IE were the youngest patient four days old and the smallest was 3.3 kg. For IE and EE patients, the median ICU LOS was 4 and 5 days, while for DE patients it was 11 days (p < 0.0001), respectively. Significantly 285 minutes and 134 minutes longer median anesthesia time and CPB time was observed in DE group as compared to the other two extubation groups (235[IE], 228[EE] minutes median anesthesia time) (80 [IE &EE] minutes CPB time), p < 0.0001 (Table 4). Significant correlation was observed between RLP, deep hypothermmia, DHCA, redo sternotomy, use of other sedatives, epinephrine, open chest, and CPS with extubation time (IE, EE or DE) (Table 5, p < 0.05). Low temperature, urine output, doses of fentanyl, dexmedetomidine, lasix, and crystalloid amount, adjusting for patient’s age, weight and length were significantly correlated with extubation group (Table 6, p < 0.05).
Thus, significant correlation was observed between IE and EE with numerous factors, including patient age and size, duration of CPB, use of certain anesthetic drugs, and the amount of blood loss and blood replacement. IE can be efficiently achieved in a majority of pediatric patients experiencing surgery for congenital heart disease, including small number of infants.
Table 1: Patient characteristic and times
Table 2: Descriptive statistics of procedures and administered medications with results of regression analyses
Table 3: Patient characteristic and times
Table 4: Descriptive statistics of procedures and administered medications with results of regression analyses
