Abstract
Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%), Down's syndrome 8.5 95%CI (1.6-43.15), failure to thrive 4.3 95%CI( 1-18). Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax) and with odds ratio 35.1 95 %CI (4-286) and blood transfusion with odds ratio 4.6 95%CI (2-12). Blood transfusion (p=0.002) (Wald=9.2) 95%CI (2-12), during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70%) and extracorporeal circulation (ECC) with cut-of 45.5 minutes (sensitivity 71% and specificity 65%).Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.
Highlights
Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation
Submitted July 14 2014 / Accepted September 24 2014 and improvements in the perioperative management strategies, that all contributed to successful outcome of surgical procedures performed on neonates, infants and children with congenital heart disease (CHD), still, almost all children undergoing congenital heart surgery require postoperativemechanical ventilation
Extubation was defined as mechanical ventilation in period shorter than 24 hours [1,2,3,4]
Summary
Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery. Submitted July 14 2014 / Accepted September 24 2014 and improvements in the perioperative management strategies, that all contributed to successful outcome of surgical procedures performed on neonates, infants and children with congenital heart disease (CHD), still, almost all children undergoing congenital heart surgery require postoperativemechanical ventilation. The aim of this study was to investigate prevalence and type of the treated congenital heart disease and to identify preoperative, intraoperative, postoperative factors associated with successful early extubation after operation. Criteria for extubation were: blood gas analyses: pH 7.32-7.47, pCO260 mmHg, with blood oxygen saturation 95%, adequate oxygenation with fraction of inspired oxygen (FiO2)≤50%, PEEP (positive end-expiratory pressure) ≤7 cm H2O, ventilatory frequency ≤8, air leak around endotracheal tube, hemodynamic stability, without signs of myocardial ischemia or significant hypotension, consistent level of consciousness with adequate protective reflexes, body temperature 80 g/dl
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