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Early postoperative extubation of unstable patients following total cavopulmonary connection: impact on circulation and outcome

Published online by Cambridge University Press:  18 October 2016

Stanimir Georgiev ,
Gunter Balling ,
Bettina Ruf ,
Kilian Ackermann ,
Jelena P. von Ohain ,
Christian Schreiber  and
Peter Ewert
Stanimir Georgiev*
Affiliation:
Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
Gunter Balling
Affiliation:
Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
Bettina Ruf
Affiliation:
Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
Kilian Ackermann
Affiliation:
Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
Jelena P. von Ohain
Affiliation:
Department for Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Germany
Christian Schreiber
Affiliation:
Department for Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Germany
Peter Ewert
Affiliation:
Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany
*
Correspondence to: S. Georgiev, Department for Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Lazarettstrasse 36, 80636, Munich, Germany. Tel: +49 89 1218 3306; Fax: +49 89 1218 3333; E-mail: georgiev@dhm.mhn.de
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Abstract

Objectives

We aimed to investigate whether early postoperative extubation following the Fontan operation is universally feasible and can be used as a management tool in unstable patients.

Methods

All patients undergoing the Fontan operation in our centre between 2004 and 2013 (n=253) were analysed. Until 2008, patients were extubated according to standard criteria and comprised group 1. Group 2 included all patients presenting after 2009, when early extubation was always aimed regardless of the haemodynamic status. Patients who exceeded the 75th percentiles for volume requirements and inotrope scores for the respective group were defined as unstable. Comparisons of outcomes between groups and subgroups and analysis of the changes in haemodynamic and treatment parameters with extubation in unstable patients after 2009 were performed.

Results

Compared with group 1, patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.50), and needed less volume (p=0.01). In group 2, the unstable patients were not ventilated for longer durations (p=0.19), but had higher re-intubation rates (p=0.03) than the stable patients. Compared with the unstable patients from group 1, the unstable patients from group 2 were ventilated for shorter duration (p<0.001), had similar re-intubation rates (p=0.66), and needed less volume (p=0.006). There was a significant acute and sustained increase in mean arterial pressure with extubation and a parallel reduction in volume requirements and inotrope scores in the unstable patients from group 2.

Conclusions

Timely extubation is universally applicable following the Fontan operation. Early postoperative extubation can be valuable for improving Fontan haemodynamics.

Keywords

Fontan operationintensive careearly extubation
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 5 , July 2017 , pp. 860 - 869
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Copyright
© Cambridge University Press 2016 

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