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Early extubation improves outcome following extracardiac total cavopulmonary connection.
Interact Cardiovasc Thorac Surg. 2019 07 01; 29(1):85-92.IC

Abstract

OBJECTIVES

The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection.

METHODS

From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients.

RESULTS

Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients.

CONCLUSIONS

Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status.

Authors+Show Affiliations

Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany.Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany.Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Technische Universität München, Munich, Germany.Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center, Technische Universität München, Munich, Germany.Department of Congenital Heart Disease, Marie Lannelongue Hospital, Les Plessis-Robinson, France.Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany. Department of Cardiovascular Surgery, Insure (Institute for Translational Cardiac Surgery), German Heart Center Munich, Technische Universität München, Munich, Germany. German Center for Cardiovascular Research, Munich, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31220277

Citation

Ono, Masamichi, et al. "Early Extubation Improves Outcome Following Extracardiac Total Cavopulmonary Connection." Interactive Cardiovascular and Thoracic Surgery, vol. 29, no. 1, 2019, pp. 85-92.
Ono M, Georgiev S, Burri M, et al. Early extubation improves outcome following extracardiac total cavopulmonary connection. Interact Cardiovasc Thorac Surg. 2019;29(1):85-92.
Ono, M., Georgiev, S., Burri, M., Mayr, B., Cleuziou, J., Strbad, M., Balling, G., Hager, A., Hörer, J., & Lange, R. (2019). Early extubation improves outcome following extracardiac total cavopulmonary connection. Interactive Cardiovascular and Thoracic Surgery, 29(1), 85-92. https://doi.org/10.1093/icvts/ivz010
Ono M, et al. Early Extubation Improves Outcome Following Extracardiac Total Cavopulmonary Connection. Interact Cardiovasc Thorac Surg. 2019 07 1;29(1):85-92. PubMed PMID: 31220277.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Early extubation improves outcome following extracardiac total cavopulmonary connection. AU - Ono,Masamichi, AU - Georgiev,Stanimir, AU - Burri,Melchior, AU - Mayr,Benedikt, AU - Cleuziou,Julie, AU - Strbad,Martina, AU - Balling,Gunter, AU - Hager,Alfred, AU - Hörer,Jürgen, AU - Lange,Rüdiger, PY - 2018/09/03/received PY - 2018/12/28/revised PY - 2019/01/03/accepted PY - 2019/6/21/pubmed PY - 2019/6/21/medline PY - 2019/6/21/entrez KW - Early extubation KW - Intensive care unit stay KW - Total cavopulmonary connection SP - 85 EP - 92 JF - Interactive cardiovascular and thoracic surgery JO - Interact Cardiovasc Thorac Surg VL - 29 IS - 1 N2 - OBJECTIVES: The aim of this study was to investigate the impact of an early extubation strategy on the outcome following extracardiac total cavopulmonary connection. METHODS: From 1999 through 2017, 458 patients underwent extracardiac total cavopulmonary connection; 257 (56%) patients were managed with an early extubation strategy adopted in 2009 (group A). Their outcome was compared with those of 201 (44%) patients treated before 2009 (group B). In group A, the outcome of unstable patients, defined as >75th percentile for volume administered and inotrope scores, was compared with those of stable patients. RESULTS: Ventilation time (median: 4 h vs 16 h, P < 0.001), fluid volume administered during the first 24 h (mean: 110 ml/kg vs 164 ml/kg, P = 0.003), chest tube duration (median: 3 days vs 4 days, P = 0.028) and length of intensive care unit stay (median: 6 days vs 7 days, P = 0.001) were less in group A than in group B. The reintubation rate (7% vs 6%, P = 0.547) and early mortality (0.8% vs 1.5%, P = 0.465) were similar between groups. The 80 unstable group A patients received more inotropic support (P < 0.001) and fluid volume (P < 0.001) than stable patients, but the ventilation time (6 h vs 5 h, P = 0.220), the reintubation rate (10% vs 6%, P = 0.283) and the length of intensive care unit stay (7 days vs 6 days, P = 0.590) were similar. In unstable patients, mean arterial pressure before extubation was significantly lower than stable patients (P = 0.001). However, mean arterial pressure in unstable patients increased significantly (P < 0.001) soon after extubation, and became similar to the value in stable patients. CONCLUSIONS: Early extubation following extracardiac total cavopulmonary connection improves postoperative haemodynamics and recovery regardless of the initial haemodynamic status. SN - 1569-9285 UR - https://www.unboundmedicine.com/medline/citation/31220277/Early_extubation_improves_outcome_following_extracardiac_total_cavopulmonary_connection_ L2 - https://academic.oup.com/icvts/article-lookup/doi/10.1093/icvts/ivz010 DB - PRIME DP - Unbound Medicine ER -