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Zhang Q, Xu J, Huang Q, Gong T, Li J, Cui Y. Risk factors for delayed extubation after pediatric perineal anaplasty in patients less than 1 year of age: a retrospective study. BMC Pediatr 2024; 24:307. [PMID: 38711038 DOI: 10.1186/s12887-024-04781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Anorectal malformation is a common congenital problem occurring in 1 in 5,000 births and has a spectrum of anatomical presentations, requiring individualized surgical treatments for normal growth. Delayed extubation or reintubation may result in a longer intensive care unit (ICU) stay and hospital stay, increased mortality, prolonged duration of mechanical ventilation, increased tracheostomy rate, and higher hospital costs. Extensive studies have focused on the role of risk factors in early extubation during major infant surgery such as Cardiac surgery, neurosurgery, and liver surgery. However, no study has mentioned the influencing factors of delayed extubation in neonates and infants undergoing angioplasty surgery. MATERIALS AND METHODS We performed a retrospective study of neonates and infants who underwent anorectal malformation surgery between June 2018 and June 2022. The principal goal of this study was to observe the incidence of delayed extubation in pediatric anorectal malformation surgery. The secondary goals were to identify the factors associated with delayed extubation in these infants. RESULTS We collected data describing 123 patients who had anorectal malformations from 2019 to 2022. It shows that 74(60.2%) in the normal intubation group and 49(39.8%) in the longer extubation. In the final model, anesthesia methods were independently associated with delayed extubation (P < 0.05). CONCLUSION We found that the anesthesia method was independently associated with early extubation in neonates and infants who accepted pediatric anorectal malformation surgery.
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Affiliation(s)
- Qianqian Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jing Xu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qinghua Huang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Tianqing Gong
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jia Li
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
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Eslaminezhad S, Moradi F, Hojjati MR. Evaluation of the wound healing efficacy of new antibacterial polymeric nanofiber based on polyethylene oxide coated with copper nanoparticles and defensin peptide: An in-vitro to in-vivo assessment. Heliyon 2024; 10:e29542. [PMID: 38628749 PMCID: PMC11019281 DOI: 10.1016/j.heliyon.2024.e29542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Today, designing nanofibers with antibacterial properties using electrospinning technology is one of the attractive approaches for wound healing. Methods & analysis: This study aims to fabricate a nanocomposite from polyethylene oxide (PEO) coated with copper nanoparticles (NPs) and defensin peptide with wound healing and antimicrobial properties in different ratios of CuNPs/defensin (2/0 mg), (1.5/0.5 mg), and (1/1 mg) in the fixed contain polymer (98 mg). Then, the nanofiber properties were investigated by SEM, tensile, DSC, and BET analysis. Also, the antibacterial properties against S. aureus and E. coli, antioxidant, and in-vivo wound healing effects and histological analysis of the designed nanocomposites were evaluated in rat models. Results Our SEM images showed that CuNPs and defensin were properly coated on the PEO surface. According to the tensile, DSC, and antibacterial analysis results, the most appropriate feature was related to CuNPs/defensin (1.5/0.5 mg), with maximum elasticity, heat resistance, and antibacterial activity. Furthermore, the designed nanocomposites showed the best performance as a wound closure agent by increasing dermis and epidermis volume density, stimulating fibroblast cells and collagen fiber production, and improving skin vessels. Conclusion According to our results, PEO nanofibers loaded with CuNPs and defensin have the best potential for wound healing, and they can be used as antibacterial materials in the textile, drug, and medical industries.
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Affiliation(s)
- Sahba Eslaminezhad
- Sahba Eslaminezhad, Department of chemical engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran
| | - Farhad Moradi
- Farhad Moradi, Department of Bacteriology & Virology, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmoud Reza Hojjati
- Mahmoud Reza Hojjati, Faculty of Engineering, Department of Chemical Engineering, Shiraz Branch, Islamic Azad University, Shiraz, Iran
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Kim CH, Lee JH, Kwon HW, Cho S, Kim WH, Ji SH, Jang YE, Kim JT, Kwak JG. Extubation in operating room versus early extubation in ICU after open-heart surgery in patients with CHDs. Cardiol Young 2024; 34:914-918. [PMID: 37981864 DOI: 10.1017/s1047951123003839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUNDS AND OBJECTIVES The "Fast track" protocol is an early extubation strategy to reduce ventilator-associated complications and induce early recovery after open-heart surgery. This study compared clinical outcomes between operating room extubation and ICU extubation after open-heart surgery in patients with CHD. METHODS We retrospectively reviewed 215 patients who underwent open-heart surgery for CHDs under the scheduled "Fast track" protocol between September 2016 and April 2022. The clinical endpoints were post-operative complications, including bleeding, respiratory and neurological complications, and hospital/ICU stays. RESULTS The patients were divided into operating room extubation (group O, n = 124) and ICU extubation (group I, n=91) groups. The most frequently performed procedures were patch closures of the atrial septal (107/215, 49.8%) and ventricular septal (89/215, 41.4%) defects. There were no significant differences in major post-operative complications or ICU and hospital stay duration between the two groups; however, patients in group I showed longer mechanical ventilatory support (0.0 min vs. 59.0 min (interquartile range: 17.0-169.0), p < 0.001). Patients in Group O showed higher initial lactate levels (3.2 ± 1.7 mg/dL versus 2.5 ± 2.0 mg/dL, p = 0.007) and more frequently used additional sedatives and opioid analgesics (33.1% versus 19.8%, p = 0.031). CONCLUSIONS Extubation in the operating room was not beneficial for patients during post-operative ICU or hospital stay. Early extubation in the ICU resulted in more stable hemodynamics in the immediate post-operative period and required less use of sedatives and analgesics.
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Affiliation(s)
- Chan Hyeong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Eun Jang
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesia and Pain medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Peters MC, Kruithof BPT, Bouten CVC, Voets IK, van den Bogaerdt A, Goumans MJ, van Wijk A. Preservation of human heart valves for replacement in children with heart valve disease: past, present and future. Cell Tissue Bank 2024; 25:67-85. [PMID: 36725733 PMCID: PMC10902036 DOI: 10.1007/s10561-023-10076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Valvular heart disease affects 30% of the new-borns with congenital heart disease. Valve replacement of semilunar valves by mechanical, bioprosthetic or donor allograft valves is the main treatment approach. However, none of the replacements provides a viable valve that can grow and/or adapt with the growth of the child leading to re-operation throughout life. In this study, we review the impact of donor valve preservation on moving towards a more viable valve alternative for valve replacements in children or young adults.
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Affiliation(s)
- M C Peters
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands.
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands.
| | - B P T Kruithof
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
| | - C V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - I K Voets
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - A van den Bogaerdt
- Heart Valve Department, ETB-BISLIFE Multi Tissue Center, 2333 BD, Beverwijk, The Netherlands
| | - M J Goumans
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - A van Wijk
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
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Özçobanoğlu S, Gündüz E, Tekerek NÜ. Comparison of ultrafast and fast track extubation after secundum atrial septal defect surgery in pediatric age group. Acta Chir Belg 2023:1-6. [PMID: 37937527 DOI: 10.1080/00015458.2023.2281097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023]
Abstract
BACGROUND Patients who underwent ultrafast track on the operating table and fast track extubation in the pediatric intensive care unit for 2 to 6 h after secundum atrial septal defect surgery in the pediatric age group were compared. METHODS Between January 2013 and February 2017, 60 pediatric patients (24 boys, 36 girls; Mean age 7.5 ± 4.6 years) whose secundum atrial defect was closed were retrospectively analyzed. The patients were separated as those who were extubated on the operating table (Group1,n = 28) and those extubated in the pediatric intensive care unit within 2-6 h postoperatively (Group2,n = 32). RESULTS No difference was found in demographic data and preoperative catheter information between the groups. Cardiopulmonary bypass time was 20(18-25)/27.5(20-30)minutes (p:0.001), the cross-clamp time was 10(10-15)/15(11-20)minutes(p:0.004), the postoperative drainage amount was 50(25-50)/60(32.5-100)ml(p:0.013), the length of stay in the intensive care unit was 1(1--1)/1(1-2)day(p:0.025), the length of stay after intensive care was 3(2-3)/3(3-4)days(p:0.001) and the total hospital stay was 4(3-4)/5(4-5.5) days (p < 0.001), which were respectively shorter for the group 1 compared to 2. Postoperative blood product replacement, positive inotrope support, pericardial effusion, mortality, and morbidity were not detected in either groups. CONCLUSION In this study, it was observed that the UFT extubation was safe for the patients who were operated for secundum ASD, in the pediatric age group, and had a cross-clamp time not exceeding 15 min. It was found that the amount of drainage, length of stay in the intensive care unit, post-intensive care unit, and the total hospital stay of patients extubated on the operating table were shorter.
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Affiliation(s)
- Salih Özçobanoğlu
- Department of Cardiovascular Surgery, Akdeniz University, Antalya, Turkey
| | - Emel Gündüz
- Department of Anesthesiology and Reanimation, Akdeniz University, Antalya, Turkey
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Kepple JW, Kendall M, Ortmann LA. Impact of Extubation Time on Feeding Outcomes after Neonatal Cardiac Surgery: A Single-Center Study. Children 2023; 10:children10030592. [PMID: 36980149 PMCID: PMC10047081 DOI: 10.3390/children10030592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023]
Abstract
This study aimed to examine the impact of timing of extubation on feeding outcomes in neonates after surgery for congenital heart disease. This was a single-center retrospective study between December 2014 and June 2020. Patients were divided into three categories: extubated in the OR (immediate), extubated in the intensive care unit (ICU) between 0 and 3 days post-procedure (early), and extubated >3 days post-procedure (delayed). Comparing the immediate and early groups, we found no difference in time to first enteral feed (1.3 days (1.0–3.4) vs. 2.3 days (1.1–3.3), p = 0.27). There was no difference in time to first oral feed (2.0 days (1.1–4.5) vs. 3.1 days (1.8–4.4), p = 0.34) and time to goal feed (6.0 days (3.2–8.3) vs. 6.9 days (5.0–9.0), p = 0.15)). There was no difference in all oral feeds at one year: 88% vs. 98%, p = 0.16. The delayed extubation group performed significantly worse on all measures. Immediate and early extubation displayed no differences in feeding outcomes and length of stay in this study, while delayed extubation performed worse on all measures. Thus, we believe that clinicians should emphasize extubation within 3 days post-surgery to improve feeding outcomes while minimizing time hospitalized.
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Affiliation(s)
- Jeffrey W. Kepple
- Department of Pediatrics, Creighton University School of Medicine, 2500 California Plaza, Omaha, NE 68178, USA
| | - Meghan Kendall
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA
| | - Laura A. Ortmann
- Department of Pediatrics, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA
- Correspondence:
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Özalp Ş, Dilek Özcanoğlu H, Öztürk E, Sağlam S, Kahraman İA, Tan ZB, Yıldız O, Özcan FG, Hatemi AC. Assessment of the factors that affect fast-track or early extubation following pediatric cardiac surgery. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:1-7. [PMID: 36926154 DOI: 10.5606/tgkdc.dergisi.2023.23206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/30/2022] [Indexed: 03/18/2023]
Abstract
Background This study aims to evaluate the early extubation rate and the factors affecting early extubation in pediatric patients undergoing cardiac surgery. Methods Between August 1st, 2020 and December 1st, 2021, a total of 528 pediatric patients (264 males, 264 females; median age: 4 months; range, 2 days to 24 months) who were followed in the pediatric cardiac intensive care unit after congenital heart surgery were retrospectively analyzed. Demographic and clinical characteristics of the patients including operation and intensive care data were obtained from the medical records. Patients included in the study were categorized into three groups as the group of patients who were extubated in the operating room (fast-track extubation), the group of patients who were extubated in the first 6 h of the operation (early extubation), the group of patients who were extubated after the postoperative 6 h or the group of patients who were not extubated or died (delayed extubation). Results Sixty-eight (12.9%) cases had fast-tract extubation, 124 (23.6%) cases had early extubation, and 335 (63.6%) cases had delayed extubation. The median age of the patients in the delayed extubation group was three months, which was significantly lower than those of the other groups (p<0.05). Reintubation rates were 1.5% in the fast-tract extubation group, 2.5% in early extubation group, and 9% in delayed extubation group (p<0.05). The median intensive care unit stay was 3, 5, and 10 days, respectively (p<0.05). Length of hospitalization was significantly higher in the delayed extubation group compared to the other groups (p<0.05). Neonatal age group, Risk Adjustment for Congenital Heart Surgery 1 score >4, Society of Thoracic Surgeons- European Association for Cardio-Thoracic Surgery mortality category >3, cardiopulmonary bypass time >100/min, vasoactive inotrope score >8, acute kidney injury >2, and low weight were found to be independent risk factors for delayed extubation. Conclusion Fast-track and early extubation can be successfully applied with low reintubation rates in selected cases with congenital heart surgery. Age, body weight, presence of genetic syndrome, operational risk category, and procedure time may affect the extubation time.
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Lundqvist-Persson C, Holmqvist G. Music education contributes to development and personal change in young adults with disabilities. Front Rehabil Sci 2022; 3:1046480. [PMID: 36619532 PMCID: PMC9816321 DOI: 10.3389/fresc.2022.1046480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
In Sweden as in many other countries, there has been increasing recognition of the importance of health, social participation, and active leisure time for people with disabilities. Against this background, a three-year music education was started for a group of young adults with disabilities in order to enhance their wellbeing, learning, and emotional and social development. The aim of the study was to evaluate the results of a 3-year education program with set goals for young adults with disabilities using a qualitative method. The study was conducted from autumn 2014 to 2018. Four semi-structured interviews were conducted with the participants, the first at the beginning of the education, after the first year, second, and third year respectively. The interviews were tape recorded and transcribed verbatim. The teachers and care staff made process notes about the development of each participant. The transcribed interviews and process notes were analyzed using Thematic Content Analysis. The education achieved its purpose and goals as evidenced by participants, teachers, and staff. It showed that music education training may revitalize people with disabilities. Furthermore, it demonstrated that persons with disabilities can learn, develop, and even change on a personal level, if they are given the right conditions.
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Altun D, Arnaz A, Doğan A, Yalçinbaş Y, Türköz R, Oktay A, Yüksek A, Altun D, Sarıoğlu T. A retrospective analysis of dexmedetomidine and morphine in the fast-track and ultra-fast-track extubation protocol after congenital cardiac surgery. J Card Surg 2022; 37:4234-4242. [PMID: 35880442 DOI: 10.1111/jocs.16709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY After congenital cardiac surgery, the duration of mechanical ventilation (MV) is related to the clinical status, type of operation, and the sedative-analgesic agents used postoperatively. This study aims to examine the effects of dexmedetomidine and morphine on the fast-track extubation (FTE) and ultra-fast-track extubation (UFTE) protocol after congenital cardiac surgery. METHODS A total of 251 pediatric patients were divided into two groups: 118 patients in the morphine group (Group M) and 133 patients in the dexmedetomidine group (Group D). We retrospectively reviewed medical data including hemodynamic parameters, duration of MV and cardiovascular intensive care unit (CICU), additional sedative/analgesic requirement, adverse events, the need for reintubation, and noninvasive MV, sedation, and pain scores. RESULTS The mean mechanical ventilation duration of Group D was significantly shorter than Group M (3.74 ± 0.83 h in Group D, 5.72 ± 1.54 h in Group M, respectively) (p = .001; p < .05). In Group D, the success rate of FTE was 92.5% (n = 123) and UFTE was 7.5% (n = 10) (p = .001). In Group M, the success rate of FTE was 72.9% (n = 86) and UFTE was 0% (n = 0) (p > .05). CONCLUSIONS Dexmedetomidine and morphine have clinical benefits which encourage their use for FTE protocol. Dexmedetomidine has more benefits compared to morphine. It can be used in UFTE protocol, besides its use in FTE protocol with fewer side effects.
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Affiliation(s)
- Dilek Altun
- Department of Anesthesiology and Reanimation, Vocational School of Health Sciences, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Yusuf Yalçinbaş
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Rıza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Demet Altun
- Department of Anesthesiology and Reanimation, Istanbul Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Tayyar Sarıoğlu
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
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Kaushik J, Vijayakumar R, Soundaravalli B, Shoba M, Jenit O, Anisha S. One-year experience after adoption of an on-table extubation protocol following pediatric cardiac surgery. Ann Card Anaesth 2022; 25:422-428. [PMID: 36254905 PMCID: PMC9732950 DOI: 10.4103/aca.aca_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To report our initial experience with on-table extubation following cardiac surgery for congenital heart disease, assessing its efficacy and safety, and the potential for fast-tracking these patients through the intensive care unit (ICU). METHODS We decided to implement a multidisciplinary protocol aiming toward on-table extubation following congenital cardiac surgery at our hospital. Between December 2018 and January 2020, 376 patients underwent congenital cardiac surgery. The management strategy involved choosing the patients preoperatively, a specific anesthetic technique, application of a standard extubation protocol, multidisciplinary team approach, and perioperative echocardiogram for assessment of surgical repair. Relevant data were collected and analyzed. RESULTS Out of the 376 patients who underwent congenital cardiac surgery during the study period, 44 patients were extubated on-table. Although a majority of these patients belonged to Risk Adjustment for Congenital Heart Surgery-1 score (RACHS-1) 1 and 2 categories, 18% of the patients who were extubated on-table were of RACHS-3 category. This included a wide spectrum of anatomical substrates such as endocardial cushion defects, pulmonary venous anomalies, single ventricle physiology, valvular defects, and others such as cor triatriatum and sinus of Valsalva aneurysm. There was no in-hospital mortality related to on-table extubation. Only one patient was reintubated following on-table extubation resulting in a reintubation rate of 2.27% among those patients extubated on-table. The patients extubated on-table had a shorter ICU stay (25.89 ± 7.20 h) compared with those patients who underwent delayed extubation (59.30 ± 6.80 h). The duration of the hospital stay was also significantly reduced in these patients (91.09 ± 20.40 h) leading to an earlier discharge compared with those patients who underwent delayed extubation (134.40 ± 16.20 h). CONCLUSION On-table extubation is an attractive alternative in limited-resource environments to enhance recovery in patients following congenital cardiac malformations. Owing to the lack of significant comorbidities such as Chronic Obstructive Pulmonary Disease (COPD) in this patient population, corrective surgery for cardiac malformation usually optimizes the cardiorespiratory status. This results in more chances of successful extubation immediately following surgery. However, this requires proper perioperative planning, a careful discussion about the choice of patients, adoption of an extubation protocol, and most importantly, a multidisciplinary team approach. It is associated with low morbidity and mortality, with reduced length of stay in the ICU and hospital. This preliminary study demonstrated that on-table extubation is feasible following congenital cardiac surgery at our center and greatly reduces the intensive care requirements. This article focuses mainly on the decision-making process which determines the ideal candidates for on-table extubation and the anesthetic protocol implemented in a low-resource environment to enable the same.
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Affiliation(s)
- Jothinath Kaushik
- Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Raju Vijayakumar
- Department of Cardiac Anesthesiology, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | | | - Menon Shoba
- Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Osborn Jenit
- Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Shajan Anisha
- Department of Cardiac Surgery, G Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
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He Y, Zhang HS, Zhang TZ, Feng Y, Zhu Y, Fan X. Analysis of the risk factors for severe lung injury after radical surgery for tetralogy of fallot. Front Surg 2022; 9:892562. [PMID: 36111236 PMCID: PMC9468228 DOI: 10.3389/fsurg.2022.892562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/21/2022] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to determine the risk factors for severe lung injury (SLI) (partial pressure of oxygen/fraction of inspired oxygen <150) after radical surgery for tetralogy of Fallot with pulmonary stenosis (TOF/PS) in children. Method A retrospective analysis was conducted including a total of 287 children with TOF/PS aged below 10 years (including 166 males) who had undergone radical surgery at the Center of Pediatric Heart Disease of the Beijing Anzhen Hospital (China) from 2018 to 2020. Results A total of 83 cases (28.9%) had SLI after surgery. Univariate analysis showed that age, weight, pulmonary artery index (PAI), cardiopulmonary bypass (CPB) time, and polymorphonuclear leukocyte (PMN) percentage on the first day after surgery were risk factors for postoperative SLI. Multivariate logistic regression analysis showed that PAI, PMN percentage on the first day postoperatively, and CPB time were independent risk factors for SLI after surgery. The prediction model was established as follows: Logit(P) = 2.236 + 0.009*CPB-0.008*PAI-0.035*PMN, area under the curve (AUC) = 0.683, P < 0.001, sensitivity 65.8%, and specificity 68.6%. Following surgery, static lung compliance was significantly lower in the SLI group compared with the routine group. Complication rates and mortality were significantly higher in the SLI than in the routine group. Ventilator support times, the length of intensive care unit stays, and the total lengths of hospital stay were significantly longer in the SLI than in the routine group. Conclusion The occurrence of SLI following radical surgery for TOF in children significantly affected postoperative recovery, and PAI, PMN percentage on the first day postoperatively, and CPB time were independent risk factors for SLI.
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Epstein R, Ohliger SJ, Cheifetz IM, Malay S, Shein SL. Trends in Time to Extubation for Pediatric Postoperative Cardiac Patients and Its Correlation With Changes in Clinical Outcomes: A Virtual PICU Database Study. Pediatr Crit Care Med 2022; 23:544-54. [PMID: 35435884 DOI: 10.1097/PCC.0000000000002950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Mechanical ventilation is often used in children after cardiac surgery but can impair hemodynamics and cause lung injury. Early extubation may improve ICU length of stay and survival. We aimed to describe trends in early extubation rates and evaluate if centers that more commonly practice early extubation have better severity-adjusted outcomes. DESIGN Retrospective analysis was performed of admissions in the Virtual Pediatric Systems (VPS, LLC) database from 2009 to 2018. Early extubation was defined as patients extubated in the operating room or within 6 hours of PICU admission. SETTING PICUs participating in the VPS database. PATIENTS Children in the VPS database who underwent cardiac surgery. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Among 69,739 subjects, 20% were neonates, 47% underwent early extubation, 5.3% failed extubation, and 2.5% died. Overall, early extubation rates did not change over the study period. Centers were placed in one of four groups based on their early extubation rate in lower complexity surgeries. Centers that most commonly used early extubation had more ICU-free time among all patients in univariable analysis (lowest early extubation group, 23.8 d [interquartile range, 18.2-25.9 d]; highest early extubation group, 24.7 d [20.0-26.2 d]; p < 0.001). After adjusting for center volume, sex, age, surgical complexity, and preoperative ICU admission, increasing center-level early extubation rates were not associated with more ICU-free days. Higher center-level early extubation rate was not associated with mortality in univariable or multivariable analysis but was associated with decreased extubation failure rate (lowest early extubation group, 6.4%; highest early extubation group, 3.6%; p < 0.001). CONCLUSIONS In this large, multicenter database study, early extubation rates in postoperative cardiac patients did not significantly change between 2009 and 2018. Centers that performed early extubation more frequently did not have shorter ICU stays or difference in mortality rates but did have lower reintubation rates.
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Ge Y, Chen Y, Hu Z, Mao H, Xu Q, Wu Q. Clinical Evaluation of on-Table Extubation in Patients Aged Over 60 Years Undergoing Minimally Invasive Mitral or Aortic Valve Replacement Surgery. Front Surg 2022; 9:934044. [PMID: 35846953 PMCID: PMC9280709 DOI: 10.3389/fsurg.2022.934044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022] Open
Abstract
Aims To evaluate the clinical efficiency of on-table extubation (OTE) versus delayed extubation in patients aged over 60 years that underwent minimally invasive mitral or aortic valve replacement surgery and evaluate the factors associated with successful OTE implementation. Materials Patients over 60 years with mitral or aortic valve disease who received minimally invasive mitral or aortic valve replacement surgery from October 2020 to October 2021 were selected retrospectively. We divided patients into the on-table extubated (OTE) group (n = 71) and the delayed extubation (DE) group (n = 22). Preoperative, intraoperative, and postoperative clinical variables were compared between the two groups. Results Patients in the DE group underwent longer surgery time, longer aortic occlusion clamping time and longer cardiopulmonary bypass time than those in the OTE group(217.48 ± 27.83 vs 275.91 ± 77.22, p = 0.002; 76.49 ± 16.00 vs 126.55 ± 54.85, p = 0.001; 112.87 ± 18.91 vs 160.77 ± 52.17, p = 0.001). Patients in the OTE group had shorter postoperative mechanical ventilation time (min), shorter ICU time, shorter postoperative hospital length of stay and lower total cost and medication cost (p < 0.05). The AUC for aortic occlusion clamping time was 0.81 (p < 0.01), making it the most significant predictor of on-table extubation success. Conclusions On-table extubation following mitral or aortic valve cardiac surgery was associated with a superior clinical outcome and high cost-effectiveness.
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Affiliation(s)
- Yunfen Ge
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yue Chen
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Zhibin Hu
- Heart Center, Department of Cardiovascular Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Hui Mao
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qiong Xu
- Center for Rehabilitation Medicine, Department of Anesthesiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qing Wu
- Center for Reproductive Medicine, Department of Gynecology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Correspondence: Qing Wu
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Koski T, Salmi H, Keski‐Nisula J, Bille A, Björnsson E, Jessen C, Forstholm R, Lääperi M, Rautiainen P. A retrospective analysis of the duration of mechanical ventilation in Scandinavian paediatric heart centres. Acta Paediatr 2022; 111:859-865. [PMID: 34981844 PMCID: PMC9304564 DOI: 10.1111/apa.16244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/16/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
AIM Early extubation after cardiac surgery shortens paediatric intensive care unit (PICU) length of stay (LOS) and decreases complications from mechanical ventilation (MV). We explored the duration of MV in Scandinavian paediatric heart centres. METHODS We retrospectively reviewed the MV duration and PICU LOS of 696 children operated for atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF) or total cavopulmonary connection (TCPC) in four Scandinavian centres in 2015-2016. Neonates (n = 90) were included regardless of heart surgery type. RESULTS Patients with ASD were extubated at a median of 3.25 h (interquartile range [IQR] 2.00-4.83), followed by patients with TCPC (median 5.00 h, IQR 2.60-16.83), VSD (median 7.00 h, IQR 3.69-22.25) and TOF (median 18.08 h, IQR 6.00-41.38). Neonates were not extubated early (median 94.42 h, IQR 45.03-138.14). Although MV durations were reflected in PICU LOS, this was not as apparent among those extubated within 12 h. The Swedish centres had shortest MV durations and PICU LOS. Extubation failed in 24/696 (3.4%) of patients. CONCLUSION Scandinavian paediatric heart centres differed in the duration of postoperative MV. Deferring extubation up to 12 h postoperatively did not markedly prolong PICU LOS.
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Affiliation(s)
- Tapio Koski
- Department of Anaesthesia and Intensive Care New Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Heli Salmi
- Department of Anaesthesia and Intensive Care New Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
- Paediatric Research Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Juho Keski‐Nisula
- Department of Anaesthesia and Intensive Care New Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anders Bille
- Department of Anaesthesiology Rigshospitalet Juliane Marie Centre Copenhagen Denmark
| | - Einar Björnsson
- Department of Anaesthesia and Intensive Care Queen Silvia's Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden
| | - Casper Jessen
- Department of Anaesthesiology Oslo University Hospital Oslo Norway
| | - Ronnie Forstholm
- Department of Pediatric Anesthesia and Intensive Care Skåne University Hospital Lund Sweden
| | - Mitja Lääperi
- Paediatric Research Centre University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Paula Rautiainen
- Department of Anaesthesia and Intensive Care New Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
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Hames DL, Sleeper LA, Bullock KJ, Feins EN, Mills KI, Laussen PC, Salvin JW. Associations With Extubation Failure and Predictive Value of Risk Analytics Algorithms With Extubation Readiness Tests Following Congenital Cardiac Surgery. Pediatr Crit Care Med 2022; 23:e208-e218. [PMID: 35184097 PMCID: PMC9058191 DOI: 10.1097/pcc.0000000000002912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Extubation failure is associated with morbidity and mortality in children following cardiac surgery. Current extubation readiness tests (ERT) do not consider the nonrespiratory support provided by mechanical ventilation (MV) for children with congenital heart disease. We aimed to identify factors associated with extubation failure in children following cardiac surgery and assess the performance of two risk analytics algorithms for patients undergoing an ERT. DESIGN Retrospective cohort study. SETTING CICU at a tertiary-care children's hospital. PATIENTS Children receiving MV greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Six hundred fifty encounters were analyzed with 49 occurrences (8%) of reintubation. Extubation failure occurred most frequently within 6 hours of extubation. On multivariable analysis, younger age (per each 3-mo decrease: odds ratio [OR], 1.06; 95% CI, 1.001-1.12), male sex (OR, 2.02; 95% CI, 1.03-3.97), Society of Thoracic Surgery-European Association for Cardiothoracic Surgery category 5 procedure (p equals to 0.005), and preoperative respiratory support (OR, 2.08; 95% CI, 1.09-3.95) were independently associated with unplanned reintubation. Our institutional ERT had low sensitivity to identify patients at risk for reintubation (23.8%; 95% CI, 9.7-47.6%). The addition of the inadequate delivery of oxygen (IDO2) index to the ERT increased the sensitivity by 19.0% (95% CI, -2.5 to 40.7%; p = 0.05), but the sensitivity remained low and the accuracy of the test dropped by 8.9% (95% CI, 4.7-13.1%; p < 0.01). CONCLUSIONS Preoperative respiratory support, younger age, and more complex operations are associated with postoperative extubation failure. IDO2 and IVCO2 provide unique cardiorespiratory monitoring parameters during ERTs but require further investigation before being used in clinical evaluation for extubation failure.
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Affiliation(s)
- Daniel L. Hames
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lynn A. Sleeper
- Department of Cardiology, Boston Children’s Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Kevin J. Bullock
- Department of Respiratory Care, Boston Children’s Hospital, Boston, MA
| | - Eric N. Feins
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, MA
- Department of Surgery, Harvard Medical School, Boston, MA
| | - Kimberly I. Mills
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital
- Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Peter C. Laussen
- Department of Anesthesia, Boston Children’s Hospital, Boston, MA
- Department of Anesthesia, Harvard Medical School, Boston, MA
| | - Joshua W. Salvin
- Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children’s Hospital
- Department of Pediatrics, Harvard Medical School, Boston, MA
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Figueroa-Solano J, Infante-Sánchez K, Espinosa-Guerra K, Astudillo-De Haro ED, Martínez-Albarenga PM, Lesprón-Robles MDC, Molina-Méndez FJ, Miranda-Chávez IO. Early Extubation in Children after Cardiac Surgery. Initial Experience from a Tertiary Care Hospital in Mexico City. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1743177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractEarly extubation (EE) in pediatric cardiac surgery has demonstrated important benefits. However, ventilating them for 24 hours or more (delayed decannulation, DD) is an enduring practice. The objectives of this study were to describe the clinical profiles of EE in our setting and analyze its impact and the factors that prolong mechanical ventilation. Children operated on for cardiac surgery from 2016 to 2017 were included. The information was obtained from an electronic database. Comparisons were performed with Pearson's chi-square test, Student's t-test, or Mann–Whitney U test. Multivariate logistic regression was used to evaluate factors associated with DD. Of 649 cases, 530 were extubated on one occasion. EE was performed in 305 children (57.5%): 97 (31.8%) in the operating room and 208 (68.2%) in the intensive care unit (ICU). Reintubation (RI) occurred in 7.5% with EE and 16.9% with DD (p = 0.001). Fewer complications and ventilation time and decreased ICU and hospital length of stay resulted with EE. Age, presurgical ventilation, emergency surgery, pump time, attempts to weaning from cardiopulmonary bypass, bleeding greater than usual, and CPR in surgery were associated with DD. EE in the National Institute of Cardiology (INC; Spanish acronym) is in the middle category and has shown benefits without compromising the patient; the fear of further complications, RI, or death is unfounded. Although not all children at the INC can be decannulated early, if there are no or minimal risk factors, it should be a priority.
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Affiliation(s)
- Javier Figueroa-Solano
- Department of Pediatric Cardiovascular Intensive Care, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
- Department of Postoperative Care, XXI Century National Medical Center, Mexican Social Security Institute, Hospital of Cardiology, Mexico City, Mexico
| | - Karen Infante-Sánchez
- Department of Cardiovascular Anesthesia, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
| | - Kenia Espinosa-Guerra
- Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
| | | | | | | | | | - Irma Ofelia Miranda-Chávez
- Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
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Martin S, Jackson K, Anton J, Tolpin DA. Pro: Early Extubation (<1 Hour) After Cardiac Surgery Is a Useful, Safe, and Cost-Effective Method in Select Patient Populations. J Cardiothorac Vasc Anesth 2022; 36:1487-1490. [PMID: 35033437 DOI: 10.1053/j.jvca.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Simon Martin
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute at Baylor St. Luke's Medical Center, and Department of Anesthesiology, Baylor College of Medicine, Houston, TX.
| | - Kirk Jackson
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute at Baylor St. Luke's Medical Center, and Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - James Anton
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute at Baylor St. Luke's Medical Center, and Department of Anesthesiology, Baylor College of Medicine, Houston, TX
| | - Daniel A Tolpin
- Division of Cardiovascular Anesthesiology at the Texas Heart Institute at Baylor St. Luke's Medical Center, and Department of Anesthesiology, Baylor College of Medicine, Houston, TX
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18
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Tirotta CF. Response to Editorial on Benefits and Risks to Incisional Analgesia. J Cardiothorac Vasc Anesth 2021; 36:351-352. [PMID: 34304982 DOI: 10.1053/j.jvca.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/11/2022]
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Fuller S, Kumar SR, Roy N, Mahle WT, Romano JC, Nelson JS, Hammel JM, Imamura M, Zhang H, Fremes SE, McHugh-Grant S, Nicolson SC. The American Association for Thoracic Surgery Congenital Cardiac Surgery Working Group 2021 consensus document on a comprehensive perioperative approach to enhanced recovery after pediatric cardiac surgery. J Thorac Cardiovasc Surg 2021; 162:931-954. [PMID: 34059337 DOI: 10.1016/j.jtcvs.2021.04.072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 12/22/2022]
Affiliation(s)
- Stephanie Fuller
- Division of Cardiothoracic Surgery, Department of Surgery, The Children's Hospital of Philadelphia, and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, and Department of Pediatrics, Keck School of Medicine of the University of Southern California, Heart Institute, Children's Hospital Los Angeles, Los Angeles, Calif.
| | - Nathalie Roy
- Department of Cardiac Surgery, Boston Children's Hospital, Department of Surgery, Harvard Medical School, Boston, Mass
| | - William T Mahle
- Division of Cardiology, Department of Pediatrics, Emory University, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Jennifer C Romano
- Departments of Cardiac Surgery and Pediatrics, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Mich
| | - Jennifer S Nelson
- Department of Cardiovascular Services, Nemours Children's Hospital, and Department of Surgery, University of Central Florida College of Medicine, Orlando, Fla
| | - James M Hammel
- Department of Cardiothoracic Surgery, Children's Hospital and Medical Center of Omaha, Omaha, Neb
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sara McHugh-Grant
- Division of Cardiothoracic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Penn
| | - Susan C Nicolson
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Penn
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20
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Yu H, Zhao DL, Ye YC, Zheng JQ, Guo YQ, Zhu T, Liang P. Extubation in the Operating Room After Transapical Transcatheter Aortic Valve Implantation Safely Improves Time-Related Outcomes and Lowers Costs: A Propensity Score-Matched Analysis. J Cardiothorac Vasc Anesth 2020; 35:1751-1759. [PMID: 32873488 DOI: 10.1053/j.jvca.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The experience of safe extubation in the operating room (OR) after transcatheter aortic valve implantation (TAVI) procedure remains not well established. The authors conducted this study to assess the effect of OR extubation in comparison with extubation in the intensive care unit (ICU) on the outcomes and cost in patients undergoing transapical-TAVI. DESIGN A propensity score-matched analysis. SETTING A single major urban teaching and university hospital. PARTICIPANTS A total of 266 patients undergoing transapical TAVI under general anesthesia between June 2015 and March 2020. INTERVENTIONS Propensity matching on pre- and intraoperative variables was used to identify 99 patients undergoing extubation in the OR versus 72 undergoing extubation in the ICU for outcome analysis. MEASUREMENTS AND MAIN RESULTS After matching, extubation in the OR showed significant reductions of length of stay (LOS) in ICU (38.8 ± 17.4 v 58.0 ± 70.0 h, difference -19.2, 95% confidence interval [CI] -35.7 to -2.7, p = 0.009) and postoperative LOS in hospital (7.1 ± 3.9 v 10.1 ± 4.6 d, difference -3.0, 95% CI -4.3 to -1.7, p < 0.0001) compared with ICU extubation, but did not significantly affect the composite incidence of any postoperative complications (46.5% [46 of 99] v 52.8% [38 of 72], difference -6.3%, 95% CI -21.5 to 8.9, p = 0.415). Also, extubation in the OR led to significant reduction of total hospital cost compared with extubation in the ICU (¥303.5 ± 17.3 v ¥329.9 ± 52.3 thousand, difference -26.2, 95% CI -38.8 to -13.7, p < 0.0001). CONCLUSIONS The current study provided evidence that extubation in the OR could be performed safely without increases in morbidity, mortality, or reintubation rate and could provide cost-effective outcome benefits in patients undergoing transapical-TAVI.
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Affiliation(s)
- Hong Yu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Dai-Liang Zhao
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Yuan-Cai Ye
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Jian-Qiao Zheng
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Tao Zhu
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China
| | - Peng Liang
- Department of Anesthesiology, West China Hospital, Sichuan University & The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China.
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Affiliation(s)
- David Faraoni
- Division of Cardiac Anesthesia, Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
| | - William C K Ng
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada; Department of Anesthesia and Pain Management, University Health Network - Toronto General Hospital, Toronto, Canada
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