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 Herz- und Gefäßchirurgie (DHM) (Prof. Krane)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 Kinderkardiologie und angeborene Herzfehler (DHM) (Prof. Ewert)2019