Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study.
This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (p = .009), greater body weight (p = .009), absence of preoperative pulmonary hypertension (p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass (p = .008) and cross-clamp (p = .022) times, lower PRISM III-24 (p < .05) and PELOD (p < .05) scores, lower inotropic score (p < .05) and vasoactive-inotropic score (p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.
Department of Pediatrics, Division of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey. odek@ankara.edu.tr.
Çağlar
Ç
Ödek
Department of Pediatrics, Division of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.
Tanıl
T
Kendirli
Department of Pediatrics, Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Tayfun
T
Uçar
Department of Pediatrics, Division of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.
Ayhan
A
Yaman
Department of Pediatrics, Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Ercan
E
Tutar
Department of Cardiovascular Surgery, Division of Pediatric Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Zeynep
Z
Eyileten
Department of Cardiovascular Surgery, Division of Pediatric Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Mehmet
M
Taşar
Department of Pediatrics, Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Mehmet
M
Ramoğlu
Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey.
Can
C
Ateş
Department of Cardiovascular Surgery, Division of Pediatric Cardiovascular Surgery, Ankara University Faculty of Medicine, Ankara, Turkey.
Adnan
A
Uysalel
Department of Pediatrics, Division of Pediatric Critical Care, Ankara University Faculty of Medicine, Ankara, Turkey.
Erdal
E
İnce
Department of Pediatrics, Division of Pediatric Cardiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Semra
S
Atalay
D000293:Adolescent; D060666:Airway Extubation; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D012189:Retrospective Studies
Cardiac surgery; Congenital heart disease; Delayed extubation; Early extubation; Mechanical ventilation; Pediatric