Early extubation improves outcome following extracardiac total cavopulmonary connection.
Airway Extubation
/ methods
Child, Preschool
Female
Follow-Up Studies
Fontan Procedure
/ methods
Heart Defects, Congenital
/ physiopathology
Hemodynamics
/ physiology
Humans
Infant
Intensive Care Units
Length of Stay
/ trends
Male
Postoperative Period
Pulmonary Artery
/ surgery
Retrospective Studies
Time Factors
Treatment Outcome
Early extubation
Intensive care unit stay
Total cavopulmonary connection
Journal
Interactive cardiovascular and thoracic surgery
ISSN: 1569-9285
Titre abrégé: Interact Cardiovasc Thorac Surg
Pays: England
ID NLM: 101158399
Informations de publication
Date de publication:
01 07 2019
01 07 2019
Historique:
received:
03
09
2018
revised:
28
12
2018
accepted:
03
01
2019
pubmed:
21
6
2019
medline:
18
12
2019
entrez:
21
6
2019
Statut:
ppublish
Résumé
The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection. From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients. Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients. Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status.
Identifiants
pubmed: 31220277
pii: 5318657
doi: 10.1093/icvts/ivz010
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
85-92Informations de copyright
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.