Risk Factors for Delayed Extubation after Ventricular Septal Defect Closure: a Prospective Observational Study.

Pankaj Garg,Kartik Patel,Divyakant Parmar,Ketav Lakhia,Jigar Surti,Himani Pandya,Ritesh Shah,Jigar Panchal

doi:10.21470/1678-9741-2017-0031

Pankaj Garg, Kartik Patel + Show 6 more

Open Access

https://doi.org/10.21470/1678-9741-2017-0031

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Abstract

ObjectiveThe objective of our study was to determine the feasibility of early extubation and to identify the risk factors for delayed extubation in pediatric patients operated for ventricular septal defect closure.MethodsA prospective, observational study was carried out at our Institute. This study involved consecutive 135 patients undergoing ventricular septal defect closure. Patients were extubated if feasible within six hours after surgery. Based on duration of extubation, patients were divided two groups: Group 1= extubation time ≤ 6 hours, Group 2= extubation time >6 hours.ResultsA total of 99 patients were in Group 1 and 36 patients in Group 2. Duration of ventilation was 4.4±0.9 hours in Group 1 and 25.9±24.9 hours in Group 2 (P<0.001). Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation. However, regression analysis revealed that only trisomy 21 (OR: 0.248; 95%CI: 0.176-0.701; P=0.001), low cardiac output syndrome (OR: 0.291; 95%CI: 0.267-0.979; P=0.001), multiple ventricular septal defect (OR: 0.243; 95%CI: 0.147-0.606; P=0.002) and vasoactive inotropic score (OR: 0.174 95%CI: 0.002-0.062; P=0.039) are strongest predictors for delayed extubation.ConclusionTrisomy 21, low cardiac output syndrome, multiple ventricular septal defect and high vasoactive inotropic score are significant risk factors for delay in extubation. Age, weight, pulmonary artery hypertension, size of ventricular septal defect, aortic cross-clamp and cardiopulmonary bypass time did not affect early extubation.

Highlights

In the inceptual era of pediatric cardiac surgery, prolonged mechanical ventilation was a norm in the postoperative care, which significantly contributed to morbidity and mortality
Univariate analysis showed that young age, low weight, low partial pressure of oxygen, trisomy 21, multiple ventricular septal defect, high vasoactive
Inotropic score, transient heart block and low cardiac output syndrome were associated with delayed extubation

Summary

Introduction

In the inceptual era of pediatric cardiac surgery, prolonged mechanical ventilation was a norm in the postoperative care, which significantly contributed to morbidity and mortality. Extubation (within 6-8 hours after surgery)[1] following pediatric cardiac surgery was initially conceptualized in the 1980s[2] This gradually received wide acceptance due to increasing number of patients and limited resources. In the modern era, where chance of error tends to zero in terms of results, early extubation has improved results tremendously in appropriate cases by reducing potential complications of prolonged mechanical ventilation. This strategy reduces intensive care unit (ICU) and hospital stay, reduces overall treatment cost and utilization of resources. We have performed a prospective observational study to identify the predictive factors for early extubation after ventricular septal defect (VSD) closure

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