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Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome.
Cardiol Young. 2017 Jul; 27(5):860-869.CY

Abstract

OBJECTIVES

We aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.

METHODS

All patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.

RESULTS

Compared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.

CONCLUSIONS

Timely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

Authors+Show Affiliations

1Department for Pediatric Cardiology and Congenital Heart Disease,German Heart Center Munich,Technical University Munich,Munich,Germany.1Department for Pediatric Cardiology and Congenital Heart Disease,German Heart Center Munich,Technical University Munich,Munich,Germany.1Department for Pediatric Cardiology and Congenital Heart Disease,German Heart Center Munich,Technical University Munich,Munich,Germany.1Department for Pediatric Cardiology and Congenital Heart Disease,German Heart Center Munich,Technical University Munich,Munich,Germany.2Department for Cardiovascular Surgery,German Heart Center Munich,Technical University Munich,Germany.2Department for Cardiovascular Surgery,German Heart Center Munich,Technical University Munich,Germany.1Department for Pediatric Cardiology and Congenital Heart Disease,German Heart Center Munich,Technical University Munich,Munich,Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27751196

Citation

Georgiev, Stanimir, et al. "Early Postoperative Extubation of Unstable Patients Following Total Cavopulmonary Connection: Impact On Circulation and Outcome." Cardiology in the Young, vol. 27, no. 5, 2017, pp. 860-869.
Georgiev S, Balling G, Ruf B, et al. Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome. Cardiol Young. 2017;27(5):860-869.
Georgiev, S., Balling, G., Ruf, B., Ackermann, K., von Ohain, J. P., Schreiber, C., & Ewert, P. (2017). Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome. Cardiology in the Young, 27(5), 860-869. https://doi.org/10.1017/S1047951116001402
Georgiev S, et al. Early Postoperative Extubation of Unstable Patients Following Total Cavopulmonary Connection: Impact On Circulation and Outcome. Cardiol Young. 2017;27(5):860-869. PubMed PMID: 27751196.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome. AU - Georgiev,Stanimir, AU - Balling,Gunter, AU - Ruf,Bettina, AU - Ackermann,Kilian, AU - von Ohain,Jelena P, AU - Schreiber,Christian, AU - Ewert,Peter, Y1 - 2016/10/18/ PY - 2016/10/19/pubmed PY - 2018/4/20/medline PY - 2016/10/19/entrez KW - Fontan operation KW - early extubation KW - intensive care SP - 860 EP - 869 JF - Cardiology in the young JO - Cardiol Young VL - 27 IS - 5 N2 - OBJECTIVES: We aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients. METHODS: All patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed. RESULTS: Compared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2. CONCLUSIONS: Timely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics. SN - 1467-1107 UR - https://www.unboundmedicine.com/medline/citation/27751196/Early_postoperative_extubation_of_unstable_patients_following_total_cavopulmonary_connection:_impact_on_circulation_and_outcome_ L2 - https://www.cambridge.org/core/product/identifier/S1047951116001402/type/journal_article DB - PRIME DP - Unbound Medicine ER -