Pro: Early Extubation Following Surgery for Congenital Heart Disease

Abstract

EARLY EXTUBATION in adult patients undergoing cardiac surgery has been shown to be safe and to decrease resource use. 1 Myles P.S. Daly D.J. Djaiani G. et al. A systematic review of the safety and effectiveness of fast-track cardiac anesthesia. Anesthesiology. 2003; 99: 982-987 Crossref PubMed Scopus (45) Google Scholar , 2 Cheng D.C. Fast track cardiac surgery pathways: Early extubation, process of care, and cost containment. Anesthesiology. 1998; 88: 1429-1433 Crossref PubMed Scopus (135) Google Scholar , 3 Cheng D.C. Karski J. Peniston C. et al. Morbidity outcome in early versus conventional tracheal extubation after coronary artery bypass grafting: A prospective randomized controlled trial. J Thorac Cardiovasc Surg. 1996; 112: 755 Abstract Full Text Full Text PDF PubMed Scopus (308) Google Scholar , 4 Cheng D.C. Fast-track cardiac surgery: Economic implications in postoperative care. J Cardiothorac Vasc Anesth. 1998; 12: 72-79 Abstract Full Text PDF PubMed Scopus (89) Google Scholar Despite several large studies showing that this practice can be extended to pediatric patients undergoing surgery for congenital heart disease (CHD), there is still a significant amount of controversy. Some centers attempt extubation as soon as possible, whereas others routinely sedate patients after surgery. A quick literature search shows that early extubation in children undergoing surgery for CHD had been introduced in the late 1970s. 5 Barash P.G. Lescovich F. Katz J.D. et al. Early extubation following pediatric cardiothoracic operation: A viable alternative. Ann Thorac Surg. 1980; 29: 228-233 Abstract Full Text PDF PubMed Scopus (86) Google Scholar , 6 Schuller J.L. Bovill J.G. Nijveld A. et al. Early extubation of the trachea after open heart surgery for congenital heart disease A review of 3 years' experience. Br J Anaesth. 1984; 56: 1101-1108 Crossref PubMed Scopus (64) Google Scholar , 7 Heard G.G. Lamberti J.J. Park S.M. et al. Early extubation after surgical repair of congenital heart disease. Crit Care Med. 1984; 13: 830-832 Crossref Scopus (48) Google Scholar Several large studies and case series have since proved that early extubation can be performed safely in simple and complex surgical cases for all age groups, including neonates. 8 Mittnacht A.J. Thanjan M. Srivastava S. et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg. 2008; 136: 88-93 Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar , 9 Kloth R.L. Baum V.C. Very early extubation in children after cardiac surgery. Crit Care Med. 2002; 30: 787-791 Crossref PubMed Scopus (69) Google Scholar , 10 Heinle J.S. Diaz L.K. Fox L.S. Early extubation after cardiac operations in neonates and young infants. J Thorac Cardiovasc Surg. 1997; 114: 413-418 Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar , 11 Vricella L.A. Dearani J.A. Gundry S.R. et al. Ultra fast track in elective congenital cardiac surgery. Ann Thorac Surg. 2000; 69: 865-871 Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar , 12 Neirotti R.A. Jones D. Hackbarth R. et al. Early extubation in congenital heart surgery. Heart Lung Circ. 2002; 11: 157-161 Abstract Full Text PDF PubMed Scopus (60) Google Scholar The term “early extubation” typically is applied when patients are extubated within 6 to 8 hours after surgery but also includes extubation in the operating room (OR) at the end of the surgical procedure. Early extubation typically is part of a fast-tracking regimen with the goal of early patient mobilization and intensive care unit (ICU) and hospital discharge, with benefits that are well documented and that will be discussed in detail below.