Chris Smith, MD
Assistant Professor of Pediatrics
Children’s Hospital of Michigan, United States
Disclosure information not submitted.
John Dentel, MD
Assistant Professor of Pediatrics
Children's Hospital of Michigan, Michigan, United States
Disclosure information not submitted.
Ahmad Farooqi, PhD
Biostatistician
Children’s Hospital of Michigan, United States
Disclosure information not submitted.
Katherine Cashen, DO
Pediatric Cardiac Intensive Care
DMC Childrens Hospital of Michigan
Durham, North Carolina
Disclosure information not submitted.
Title: Early extubation guideline decreases length of mechanical ventilation in pediatric cardiac surgery
Introduction: Early extubation, within the first 6 hours after pediatric cardiac surgery has become common. Benefits of early extubation include decreased exposure to sedation and narcotics, lower cost, decreased ventilator associated complications and physiologic benefits in certain cardiac lesions. Substantial variability exists in early extubation practices. Our objective was to determine whether implementing an early extubation guideline decreased duration of mechanical ventilation. We also report associations with adverse outcomes.
Methods: This is an IRB exempt retrospective study. Children who underwent surgical repair for select STAT Category 1-3 procedures detailed in the early extubation guideline were included. Hospital, patient, operative and postoperative data were collected for the period prior to initiation of the guideline (Jan 2016-Dec 2017; PRE) and the period after implementation (Jan 2018-Dec 2019; POST.) Groups were analyzed using standard statistical procedures in SAS.
Results: Of the 234 patients included, 140 (60%) were in the PRE era and 94 (40%) were in the POST era. In univariable analysis, PRE era was associated with longer duration of mechanical ventilation (12 ±17 hours PRE vs. 0 ±18 hours POST, p< 0.01), shorter CPB time, less blood product transfusion, and increased benzodiazepine and cumulative narcotic administration. There was no difference in rate of reintubation between the groups or other adverse outcomes including CPR, ECMO, use of heliox or NIPPV or vocal cord dysfunction. There was no difference in ICU length of stay between the two groups (8.7±14.1 PRE vs 7.4±8.2 POST, p >0.05.) In bivariate analysis, POST era was associated with increased early extubation (OR 2.77: 95CI; 1.61-4.77.)
Conclusions: Implementation of an early extubation guideline significantly decreased duration of mechanical ventilation without a change in rate of reintubation or adverse events in select patients. Standardization of early extubation practice was associated with decreased duration of mechanical ventilation without adverse events and may decrease cumulative benzodiazepine and narcotic exposure.