Predictors of early extubation after pediatric cardiac surgery: Fifteen months of institutional experience

• Published in: Progress in pediatric cardiology Vol. 57; p. 101224
• Main Authors: Montoro, Delia Valverde, Gómez, Jose Manuel González, Montoro, Alvaro Valverde, Manso, Guillermo Milano
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.06.2020
• Subjects: Cardiac surgery; Congenital heart disease; Early extubation; Mechanical ventilation; Pediatric intensive care unit; Postoperative care; Congenital heart disease; Cardiac surgery; Pediatric intensive care unit; Mechanical ventilation; Postoperative care; Early extubation
• ISSN: 1058-9813; 1558-1519
• DOI: 10.1016/j.ppedcard.2020.101224

The many advantages of early extubation following cardiac surgery in children are now widely recognized. We sought to identify factors associated with successful and early extubation in children undergoing congenital heart surgery, including neonates (aged <30 days). From June 2017 to September 2018 a total of 145 patients, including 17 neonates (12%) and 76 (52%) children aged under 1 year underwent 155 surgeries. Early and delayed extubation were defined respectively as removal of the endotracheal tube within 6 h or >6 h from arrival to PICU following cardiac surgery. Demographic, preoperative, intraoperative, and postoperative data were analysed retrospectively. Early extubation (<6 h) was achieved in 59% of the cases. In 10 cases an initial extubation attempt failed at a median of 17 h with a global failed extubation rate of 6.5%. Multivariate logistic regression analyses were used to determine independent relationships between perioperative factors and early extubation and demonstrated that predictors of early extubation included a lower Risk Adjustment in Congenital Heart Surgery (RACHS-1) scores and the absence of preoperative mechanical ventilation. We established that successful early extubation can be accomplished within the first 6 post-surgery hours in low-to-medium risk pediatric cardiac surgery patients. •Early extubation can be accomplished within the first 6 post-surgery hours in low-to-medium risk pediatric cardiac surgery patients•The potential advantages of early extubation after congenital heart surgery could include decreases in ventilator-associated pneumonia, shorter PICU and hospital length of stay, and decreased cost per case.•Close collaboration between the surgical, anesthesia, and intensive care teams is essential to appropriately identify early extubation candidates and to coordinate their care accordingly.