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Fast-track extubation after modified Fontan procedure.
J Thorac Cardiovasc Surg. 2012 Sep; 144(3):547-52.JT

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+Show Affiliations

Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22743174

Citation

Mutsuga, Masato, et al. "Fast-track Extubation After Modified Fontan Procedure." The Journal of Thoracic and Cardiovascular Surgery, vol. 144, no. 3, 2012, pp. 547-52.
Mutsuga M, Quiñonez LG, Mackie AS, et al. Fast-track extubation after modified Fontan procedure. J Thorac Cardiovasc Surg. 2012;144(3):547-52.
Mutsuga, M., Quiñonez, L. G., Mackie, A. S., Norris, C. M., Marchak, B. E., Rutledge, J. M., Rebeyka, I. M., & Ross, D. B. (2012). Fast-track extubation after modified Fontan procedure. The Journal of Thoracic and Cardiovascular Surgery, 144(3), 547-52. https://doi.org/10.1016/j.jtcvs.2012.05.047
Mutsuga M, et al. Fast-track Extubation After Modified Fontan Procedure. J Thorac Cardiovasc Surg. 2012;144(3):547-52. PubMed PMID: 22743174.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fast-track extubation after modified Fontan procedure. AU - Mutsuga,Masato, AU - Quiñonez,Luis G, AU - Mackie,Andrew S, AU - Norris,Colleen M, AU - Marchak,B Elaine, AU - Rutledge,Jennifer M, AU - Rebeyka,Ivan M, AU - Ross,David B, Y1 - 2012/06/27/ PY - 2011/06/20/received PY - 2012/05/07/revised PY - 2012/05/16/accepted PY - 2012/6/30/entrez PY - 2012/6/30/pubmed PY - 2012/12/10/medline SP - 547 EP - 52 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 144 IS - 3 N2 - 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. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/22743174/Fast_track_extubation_after_modified_Fontan_procedure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(12)00587-9 DB - PRIME DP - Unbound Medicine ER -