Early extubation improves outcome following extracardiac total cavopulmonary connection.

Ono, Masamichi; Georgiev, Stanimir; Burri, Melchior; Mayr, Benedikt; Cleuziou, Julie; Strbad, Martina; Balling, Gunter; Hager, Alfred; Hörer, Jürgen; Lange, Rüdiger

doi:10.1093/icvts/ivz010

2019

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Title:: Early extubation improves outcome following extracardiac total cavopulmonary connection.
Document type:: Journal Article
Author(s):: Ono, Masamichi; Georgiev, Stanimir; Burri, Melchior; Mayr, Benedikt; Cleuziou, Julie; Strbad, Martina; Balling, Gunter; Hager, Alfred; Hörer, Jürgen; Lange, Rüdiger
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.
Journal title abbreviation:: Interact Cardiovasc Thorac Surg
Year:: 2019
Journal volume:: 29
Journal issue:: 1
Pages contribution:: 85-92
Fulltext / DOI:: doi:10.1093/icvts/ivz010
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/31220277
Print-ISSN:: 1569-9293
TUM Institution:: Klinik für Herz- und Gefäßchirurgie (Prof. Lange); Klinik für Kinderkardiologie und angeborene Herzfehler (Prof. Hess)
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mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2019

mediaTUM Gesamtbestand Einrichtungen Schools TUM School of Medicine and Health Departments Clinical Medicine Lehr- und Forschungskooperationen mit den Kliniken und Instituten am Deutschen Herzzentrum Klinik für Herz- und Gefäßchirurgie (DHM) (Prof. Krane)2019