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Very early extubation in children after cardiac surgery.
Crit Care Med. 2002 Apr; 30(4):787-91.CC

Abstract

OBJECTIVE

Very early extubation of children after cardiac surgery has been suggested as a safe alternative to prolonged postoperative intubation but is still not common practice. Studies of early extubation in children may not have described reasons for failure to extubate, or have included nonbypass or only low-risk repairs. We present our experience with very early extubation in an inclusive group of children after cardiac surgery.

DESIGN

Retrospective chart review.

SETTING

University hospital operating room and pediatric intensive care unit (ICU).

PATIENTS

A total of 102 consecutive children (age <18 yrs) undergoing cardiac surgery requiring cardiopulmonary bypass.

MAIN RESULTS

Forty-eight patients were extubated early (88% in the operating room, 12% on arrival in ICU). Patients extubated late were younger (13.8 +/- 26.2 vs. 47.6 +/- 44.5 months), smaller (8.1 +/- 10.7 vs.17.5 +/- 14.2 kg), and had higher ASA scores than patients extubated early (p <.001 for all). The youngest patient extubated early was 2 months old (range, 2-192 months). Paco2 on ICU arrival was higher in the early extubation group (52.4 +/- 6.9 vs. 41.2 +/- 14.7 mm Hg [7.0 +/- 0.9 vs. 5.5 +/- 2.0 kPa], p <.001), and pH was lower (7.27 +/- 0.04 vs. 7.37 +/- 0.16, p <.001). Use of subarachnoid morphine did not affect ability to extubate early. No patients in the early extubation group required special airway support, reintubation, or increased inotropic support after ICU admission.

CONCLUSIONS

Successful early extubation of even young children is possible and easily accomplished in most children undergoing cardiopulmonary bypass, even with complex procedures, but advantages of extubation in the operating room vs. immediate ICU extubation remain unclear. Transient mild-to-moderate mixed acidosis is common and requires no treatment. Full implementation requires acceptance by surgical and ICU staffs.

Authors+Show Affiliations

Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11940746

Citation

Kloth, Robin L., and Victor C. Baum. "Very Early Extubation in Children After Cardiac Surgery." Critical Care Medicine, vol. 30, no. 4, 2002, pp. 787-91.
Kloth RL, Baum VC. Very early extubation in children after cardiac surgery. Crit Care Med. 2002;30(4):787-91.
Kloth, R. L., & Baum, V. C. (2002). Very early extubation in children after cardiac surgery. Critical Care Medicine, 30(4), 787-91.
Kloth RL, Baum VC. Very Early Extubation in Children After Cardiac Surgery. Crit Care Med. 2002;30(4):787-91. PubMed PMID: 11940746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Very early extubation in children after cardiac surgery. AU - Kloth,Robin L, AU - Baum,Victor C, PY - 2002/4/10/pubmed PY - 2002/5/4/medline PY - 2002/4/10/entrez SP - 787 EP - 91 JF - Critical care medicine JO - Crit. Care Med. VL - 30 IS - 4 N2 - OBJECTIVE: Very early extubation of children after cardiac surgery has been suggested as a safe alternative to prolonged postoperative intubation but is still not common practice. Studies of early extubation in children may not have described reasons for failure to extubate, or have included nonbypass or only low-risk repairs. We present our experience with very early extubation in an inclusive group of children after cardiac surgery. DESIGN: Retrospective chart review. SETTING: University hospital operating room and pediatric intensive care unit (ICU). PATIENTS: A total of 102 consecutive children (age <18 yrs) undergoing cardiac surgery requiring cardiopulmonary bypass. MAIN RESULTS: Forty-eight patients were extubated early (88% in the operating room, 12% on arrival in ICU). Patients extubated late were younger (13.8 +/- 26.2 vs. 47.6 +/- 44.5 months), smaller (8.1 +/- 10.7 vs.17.5 +/- 14.2 kg), and had higher ASA scores than patients extubated early (p <.001 for all). The youngest patient extubated early was 2 months old (range, 2-192 months). Paco2 on ICU arrival was higher in the early extubation group (52.4 +/- 6.9 vs. 41.2 +/- 14.7 mm Hg [7.0 +/- 0.9 vs. 5.5 +/- 2.0 kPa], p <.001), and pH was lower (7.27 +/- 0.04 vs. 7.37 +/- 0.16, p <.001). Use of subarachnoid morphine did not affect ability to extubate early. No patients in the early extubation group required special airway support, reintubation, or increased inotropic support after ICU admission. CONCLUSIONS: Successful early extubation of even young children is possible and easily accomplished in most children undergoing cardiopulmonary bypass, even with complex procedures, but advantages of extubation in the operating room vs. immediate ICU extubation remain unclear. Transient mild-to-moderate mixed acidosis is common and requires no treatment. Full implementation requires acceptance by surgical and ICU staffs. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/11940746/Very_early_extubation_in_children_after_cardiac_surgery_ L2 - https://dx.doi.org/10.1097/00003246-200204000-00011 DB - PRIME DP - Unbound Medicine ER -