title: Fast-track extubation after modified Fontan procedure.
abstract: OBJECTIVE
  In 2007, we introduced a policy to plan to extubate all patients after a modified Fontan procedure in the operating room. Our objective was to review the feasibility, safety, and clinical outcomes of this approach.
  
  
  METHODS
  Patients who underwent a modified Fontan operation between May 2004 and May 2010 were reviewed.
  
  
  RESULTS
  Ninety-seven patients underwent a modified Fontan operation (mean age, 3.9 ± 2.2 years; mean weight, 15.1 ± 5.0 kg); 46 patients (47%) were extubated in the operating room (group A). Nineteen patients were extubated in the intensive care unit within 24 hours (group B), and 32 patients had delayed extubation (group C). The 3 groups were not significantly different with respect to preoperative characteristics. Twenty-four hours postoperatively, group A had a lower mean central venous pressure compared with patients in group B or C (13 vs 14 vs 17 mm Hg, respectively, P < .001); a higher base excess (0.4 vs -1.3 vs -3.4, P < .001); a lower fluid balance (234 vs 514 vs 730 mL, P < .001); and a lower inotrope score (4.6 vs 6.7 vs 10.8, P < .001). Group C had a longer median intensive care unit length of stay (2 vs 3 vs 6 nights, P = .01), kept their chest tubes longer (8 vs 9 vs 15 days, P = .001), and had a longer median hospital length of stay (9 vs 11 vs 21 days, P = .001).
  
  
  CONCLUSIONS
  Extubation in the operating room after a modified Fontan procedure seems feasible. This approach is associated with improved early postoperative hemodynamics, earlier time to chest tube removal, and shorter intensive care unit and hospital lengths of stay.
authors: Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
authors: Masato
authors: M
authors: Mutsuga
authors: Luis G
authors: LG
authors: Quiñonez
authors: Andrew S
authors: AS
authors: Mackie
authors: Colleen M
authors: CM
authors: Norris
authors: B Elaine
authors: BE
authors: Marchak
authors: Jennifer M
authors: JM
authors: Rutledge
authors: Ivan M
authors: IM
authors: Rebeyka
authors: David B
authors: DB
authors: Ross
mesh_terms: D000136:Acid-Base Equilibrium; D060666:Airway Extubation / Q000009:adverse effects; D000416:Alberta; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005240:Feasibility Studies; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D015397:Program Evaluation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014690:Venous Pressure; D014882:Water-Electrolyte Balance