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Early extubation strategy after congenital heart surgery: 1-year single-centre experience

Published online by Cambridge University Press:  07 June 2021

Lyudmil Simeonov Open the ORCID record for Lyudmil Simeonov [Opens in a new window] ,
Dimitar Pechilkov ,
Anna Kaneva ,
Mary C. McLellan  and
Kathy Jenkins
Lyudmil Simeonov*
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Dimitar Pechilkov
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Anna Kaneva
Affiliation:
Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria
Mary C. McLellan
Affiliation:
Department of Cardiology, Children’s Hospital, Boston, MA, USA
Kathy Jenkins
Affiliation:
Department of Cardiology, Children’s Hospital, Boston, MA, USA
*
Author for correspondence: Lyudmil Simeonov, Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria. Tel: +359886848285. E-mail: [email protected]
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Abstract

Introduction:

Our aim was to present the initial experience with a protocol-driven early extubation strategy and to identify risk factors associated with failed spontaneous breathing trials within 12 hours after surgery.

Methods:

A single institutional retrospective study of children up to 18 years of age was conducted in post-operative cardiac surgical patients over a 1-year period. A daily spontaneous breathing trial protocol was used to assess patients’ readiness for extubation. The study population (n = 129) was stratified into two age groups: infants (n = 84) and children (n = 45), and further stratified according to ventilation time: early extubation (ventilation time less than 12 h, n = 86) and deferred extubation (ventilation time more than 12 h, n = 43). Mann–Whitney U-test and binomial logistic regression were used for statistical analysis.

Results:

Early extubated infants had shorter ICU (4 versus 6 days, p = 0.003) and hospital length of stays (16 versus 19 days, p = 0.006), lower re-intubation rates (1 versus 7 patients, p = 0.003), and lower mortality (0 versus. 4 patients, p = 0.01) than deferred extubated infants. There was no significant difference in the studied outcomes in the children group. Malnourished infants and longer cardiopulmonary bypass times were independently associated with failed spontaneous breathing trials within 12 hours after cardiac surgery.

Conclusions:

Early extubated infants after cardiac surgery had shorter ICU and hospital length of stay, without an increase in morbidity and mortality, compared to infants who deferred extubation. Nutritional status and longer cardiopulmonary bypass times were risk factors for failed spontaneous breathing trial.

Keywords

Early extubationcongenital heart surgeryextubation protocol
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 3 , March 2022 , pp. 357 - 363
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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