Early extubation improves outcome following extracardiac total cavopulmonary connection. (13th February 2019)

• Record Type: Journal Article
• Authors: Ono, Masamichi; Georgiev, Stanimir; Burri, Melchior; Mayr, Benedikt; Cleuziou, Julie; Strbad, Martina; Balling, Gunter; Hager, Alfred; Hörer, Jürgen; Lange, Rüdiger
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 29:Number 1(2019)
• Page Start: 85
• Page End: 92
• Publication Date: 2019-02-13
• Subjects: Total cavopulmonary connection -- Early extubation -- Intensive care unit stay; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivz010
• Languages: English
• ISSNs: 1569-9293

Abstract

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.