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Early Extubation in the Operating Room after Congenital Open-Heart Surgery.
Int Heart J. 2018 Jan 27; 59(1):94-98.IH

Abstract

Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation.

Authors+Show Affiliations

Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.Department of Anesthesiology, Kitasato University School of Medicine.Department of Cardiovascular Surgery, Kitasato University School of Medicine.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29332913

Citation

Fukunishi, Takuma, et al. "Early Extubation in the Operating Room After Congenital Open-Heart Surgery." International Heart Journal, vol. 59, no. 1, 2018, pp. 94-98.
Fukunishi T, Oka N, Yoshii T, et al. Early Extubation in the Operating Room after Congenital Open-Heart Surgery. Int Heart J. 2018;59(1):94-98.
Fukunishi, T., Oka, N., Yoshii, T., Kobayashi, K., Inoue, N., Horai, T., Kitamura, T., Okamoto, H., & Miyaji, K. (2018). Early Extubation in the Operating Room after Congenital Open-Heart Surgery. International Heart Journal, 59(1), 94-98. https://doi.org/10.1536/ihj.16-630
Fukunishi T, et al. Early Extubation in the Operating Room After Congenital Open-Heart Surgery. Int Heart J. 2018 Jan 27;59(1):94-98. PubMed PMID: 29332913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early Extubation in the Operating Room after Congenital Open-Heart Surgery. AU - Fukunishi,Takuma, AU - Oka,Norihiko, AU - Yoshii,Takeshi, AU - Kobayashi,Kensuke, AU - Inoue,Nobuyuki, AU - Horai,Tetsuya, AU - Kitamura,Tadashi, AU - Okamoto,Hirotsugu, AU - Miyaji,Kagami, Y1 - 2018/01/15/ PY - 2018/1/16/pubmed PY - 2018/2/7/medline PY - 2018/1/16/entrez KW - RACHS-1 SP - 94 EP - 98 JF - International heart journal JO - Int Heart J VL - 59 IS - 1 N2 - Early extubation in the operating room after congenital open-heart surgery is feasible, but extubation in the intensive care unit after the operation remains common practice at many institutions. The purpose of this study was to evaluate retrospectively the adequacy of our early-extubation strategy and exclusion criteria through analysis based on the Risk Adjustment in Congenital Heart Surgery method (RACHS-1).This retrospective analysis included 359 cases requiring cardiopulmonary bypass (male, 195; female, 164; weight > 3.0 kg; aged 1 month to 18 years). Neonates and preoperatively intubated patients were excluded. Other exclusion criteria included severe preoperative pulmonary hypertension, high-dose catecholamine requirement after cardiopulmonary bypass, delayed sternal closure, laryngomalacia, serious bleeding, and delayed awakening. The early-extubation rates were compared between age groups and RACHS-1 classes.Overall, 83% of cases (298/359) were extubated in the operating room, classified by RACHS-1 categories as follows: 1, 59/59 (100%); 2, 164/200 (84%); 3, 61/78 (78%); and 4-6, 10/22 (45%). The early extubation rate in categories 1-3 (86%, 288/337) was significantly higher than for categories 4-6 (45.5%, 10/22) (P < 0.001). Because they met one of the exclusion criteria, 61 patients (17%) were not extubated in the operating room. Eight patients (2.7%) required re-intubation after early extubation in the operating room, and longer operation time was significantly associated with re-intubation (P < 0.001).Extubation in the operating room after congenital open-heart surgery was feasible based on our criteria, especially for patients in the low RACHS-1 categories, and involves a very low rate of re-intubation. SN - 1349-3299 UR - https://www.unboundmedicine.com/medline/citation/29332913/Early_Extubation_in_the_Operating_Room_after_Congenital_Open_Heart_Surgery_ L2 - https://dx.doi.org/10.1536/ihj.16-630 DB - PRIME DP - Unbound Medicine ER -