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Extubation on the operating table in patients with right ventricular pressure overload undergoing biventricular repair†.

Abstract

OBJECTIVES

Right ventricular pressure overload, which can result in restrictive right ventricular physiology, predicts slow recovery after biventricular repair of congenital heart defects. The goal of the study was to assess how extubation in the operating room influences the postoperative course in these patients.

METHODS

Between January 2013 and June 2017, a total of 65 children [median age 0.96 (0.13-9.47) years; median weight 8 (3.05-25.8) kg] with right ventricular pressure overload underwent an intracardiac correction. The most common malformations were tetralogy of Fallot (n = 34) and double outlet right ventricle with pulmonary stenosis (n = 11). The patients were divided into 2 groups: the first (n = 36) comprised late extubated (LE) and the second (n = 29), early extubated (EE) children, immediately after chest closure in the operating room. Preoperative, perioperative and postoperative records were analysed retrospectively.

RESULTS

Children who had EE had a lower heart rate (EE 124.2 vs LE 133.6 bpm; P = 0.03), higher arterial blood pressure (systolic: EE 87.9 ± 9.35 vs LE 81.4 ± 12.0 mmHg; P = 0.029; diastolic: EE 51.1 ± 6.5 vs LE 45.9 ± 6.64 mmHg; P = 0.003), lower central venous pressure (EE 8.6 ± 1.89 mmHg vs LE 9.9 ± 2.42 mmHg; P = 0.03), fewer pleural effusions in the first 6 postoperative days (EE 1.38 ml/kg/day vs LE 5.98 ml/kg/day; P = 0.009), shorter time of dopamine support ≥3 μg/kg (EE 7.29 ± 12.26 h vs LE 34.78 ± 38.05 h, P < 0.001), shorter stays in the intensive care unit (EE 2.7 ± 2.67 vs LE 5.0 ± 4.77 days, P = 0.001) and hospital (EE 11.8 ± 4.79 vs LE 15.5 ± 7.8 days; P = 0.022).

CONCLUSIONS

Extubation in the operating room of children with right ventricular pressure overload undergoing biventricular correction is feasible and safe and has a beneficial effect on the postoperative course.

Authors+Show Affiliations

Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany.Department of Pediatric Cardiology, University Hospital Münster, Münster, Germany.Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.Division of Pediatric Cardiac Surgery, Department of Cardiothoracic Surgery, University Hospital Münster, Münster, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31323661

Citation

Nawrocki, Pawel, et al. "Extubation On the Operating Table in Patients With Right Ventricular Pressure Overload Undergoing Biventricular Repair†." European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, 2019.
Nawrocki P, Wisniewski K, Schmidt C, et al. Extubation on the operating table in patients with right ventricular pressure overload undergoing biventricular repair†. Eur J Cardiothorac Surg. 2019.
Nawrocki, P., Wisniewski, K., Schmidt, C., Bruenen, A., Debus, V., Malec, E., & Januszewska, K. (2019). Extubation on the operating table in patients with right ventricular pressure overload undergoing biventricular repair†. European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery, doi:10.1093/ejcts/ezz139.
Nawrocki P, et al. Extubation On the Operating Table in Patients With Right Ventricular Pressure Overload Undergoing Biventricular Repair†. Eur J Cardiothorac Surg. 2019 Apr 28; PubMed PMID: 31323661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extubation on the operating table in patients with right ventricular pressure overload undergoing biventricular repair†. AU - Nawrocki,Pawel, AU - Wisniewski,Konrad, AU - Schmidt,Christoph, AU - Bruenen,Andreas, AU - Debus,Volker, AU - Malec,Edward, AU - Januszewska,Katarzyna, Y1 - 2019/04/28/ PY - 2018/11/16/received PY - 2019/03/10/revised PY - 2019/03/13/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline KW - Biventricular repair KW - Extubation in the operating room KW - Restrictive right ventricular physiology KW - Right ventricular pressure overload JF - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JO - Eur J Cardiothorac Surg N2 - OBJECTIVES: Right ventricular pressure overload, which can result in restrictive right ventricular physiology, predicts slow recovery after biventricular repair of congenital heart defects. The goal of the study was to assess how extubation in the operating room influences the postoperative course in these patients. METHODS: Between January 2013 and June 2017, a total of 65 children [median age 0.96 (0.13-9.47) years; median weight 8 (3.05-25.8) kg] with right ventricular pressure overload underwent an intracardiac correction. The most common malformations were tetralogy of Fallot (n = 34) and double outlet right ventricle with pulmonary stenosis (n = 11). The patients were divided into 2 groups: the first (n = 36) comprised late extubated (LE) and the second (n = 29), early extubated (EE) children, immediately after chest closure in the operating room. Preoperative, perioperative and postoperative records were analysed retrospectively. RESULTS: Children who had EE had a lower heart rate (EE 124.2 vs LE 133.6 bpm; P = 0.03), higher arterial blood pressure (systolic: EE 87.9 ± 9.35 vs LE 81.4 ± 12.0 mmHg; P = 0.029; diastolic: EE 51.1 ± 6.5 vs LE 45.9 ± 6.64 mmHg; P = 0.003), lower central venous pressure (EE 8.6 ± 1.89 mmHg vs LE 9.9 ± 2.42 mmHg; P = 0.03), fewer pleural effusions in the first 6 postoperative days (EE 1.38 ml/kg/day vs LE 5.98 ml/kg/day; P = 0.009), shorter time of dopamine support ≥3 μg/kg (EE 7.29 ± 12.26 h vs LE 34.78 ± 38.05 h, P < 0.001), shorter stays in the intensive care unit (EE 2.7 ± 2.67 vs LE 5.0 ± 4.77 days, P = 0.001) and hospital (EE 11.8 ± 4.79 vs LE 15.5 ± 7.8 days; P = 0.022). CONCLUSIONS: Extubation in the operating room of children with right ventricular pressure overload undergoing biventricular correction is feasible and safe and has a beneficial effect on the postoperative course. SN - 1873-734X UR - https://www.unboundmedicine.com/medline/citation/31323661/Extubation_on_the_operating_table_in_patients_with_right_ventricular_pressure_overload_undergoing_biventricular_repair† L2 - https://academic.oup.com/ejcts/article-lookup/doi/10.1093/ejcts/ezz139 DB - PRIME DP - Unbound Medicine ER -