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J Pediatr Intensive Care
DOI: 10.1055/s-0042-1743177
Original Article

Early Extubation in Children after Cardiac Surgery. Initial Experience from a Tertiary Care Hospital in Mexico City

Javier Figueroa-Solano 
1   Department of Pediatric Cardiovascular Intensive Care, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
2   Department of Postoperative Care, XXI Century National Medical Center, Mexican Social Security Institute, Hospital of Cardiology, Mexico City, Mexico
,
Karen Infante-Sánchez
3   Department of Cardiovascular Anesthesia, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Kenia Espinosa-Guerra
4   Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Esteban David Astudillo-De Haro
4   Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Paola María Martínez-Albarenga
4   Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Ma del Carmen Lesprón-Robles
3   Department of Cardiovascular Anesthesia, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Francisco Javier Molina-Méndez
3   Department of Cardiovascular Anesthesia, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
,
Irma Ofelia Miranda-Chávez
4   Department of Pediatric Cardiology, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico
› Author Affiliations Funding None.
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Abstract

Early 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.

Keywords

early extubation - pediatric cardiac surgery


Publication History

Received: 21 December 2021

Accepted: 27 December 2021

Article published online:
21 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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