Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery
Background In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to “ultra‐fast‐track” anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020201 |
| _version_ | 1811275172513054720 |
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| author | Paolo Bianchi Andrew Constantine Giulia Costola Sara Mele Darryl Shore Konstantinos Dimopoulos Tuan‐Chen Aw |
| author_facet | Paolo Bianchi Andrew Constantine Giulia Costola Sara Mele Darryl Shore Konstantinos Dimopoulos Tuan‐Chen Aw |
| author_sort | Paolo Bianchi |
| collection | DOAJ |
| description | Background In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to “ultra‐fast‐track” anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery. Methods And Results Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactive‐inotropic score 0.5 [0.0–2.0] versus 2.0 [0.0–3.5]; P<0.0001) and had a lower total net fluid balance than patients after conventional extubation (1168±723 versus 847±733 mL; P=0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a “step‐down” to ward‐based care (48 [45–50] versus 50 [47–69] hours; P=0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430–4222] versus £4166 [3893–5603]; P<0.0001). Conclusions In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower health‐care‐related costs. |
| first_indexed | 2024-04-12T23:33:18Z |
| format | Article |
| id | doaj.art-ffd65602f9b2499da8e48e7e36065423 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-12T23:33:18Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ffd65602f9b2499da8e48e7e360654232022-12-22T03:12:14ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101110.1161/JAHA.120.020201Ultra‐Fast‐Track Extubation in Adult Congenital Heart SurgeryPaolo Bianchi0Andrew Constantine1Giulia Costola2Sara Mele3Darryl Shore4Konstantinos Dimopoulos5Tuan‐Chen Aw6Department of Anaesthesia and Intensive Care Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomAdult Congenital Heart Centre and National Centre for Pulmonary Hypertension Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomAdult Congenital Heart Centre and National Centre for Pulmonary Hypertension Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomDepartment of Anaesthesia and Intensive Care Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomAdult Congenital Heart Centre and National Centre for Pulmonary Hypertension Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomAdult Congenital Heart Centre and National Centre for Pulmonary Hypertension Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomDepartment of Anaesthesia and Intensive Care Royal Brompton HospitalGuy’s and St Thomas’ NHS Foundation Trust London United KingdomBackground In pediatric cardiac surgery, perioperative management has evolved from slow weaning of mechanical ventilation in the intensive care unit to “ultra‐fast‐track” anesthesia with early extubation (EE) in theater to promote a faster recovery. The strategy of EE has not been assessed in adults with congenital heart disease, a growing population of patients who often require surgery. Methods And Results Data were collected retrospectively on all patients >16 years of age who underwent adult congenital heart surgery in our tertiary center between December 2012 and January 2020. Coarsened exact matching was performed for relevant baseline variables. Overall, 711 procedures were performed: 133 (18.7%) patients underwent EE and 578 (81.3%) patients received conventional extubation. After matching, patients who received EE required less inotropic or vasopressor support in the early postoperative period (median Vasoactive‐inotropic score 0.5 [0.0–2.0] versus 2.0 [0.0–3.5]; P<0.0001) and had a lower total net fluid balance than patients after conventional extubation (1168±723 versus 847±733 mL; P=0.0002). The overall reintubation rate was low at 0.3%. EE was associated with a significantly shorter postoperative length of stay in higher dependency care units before a “step‐down” to ward‐based care (48 [45–50] versus 50 [47–69] hours; P=0.004). Lower combined intensive care unit and high dependency unit costs were incurred by patients who received EE compared with patients who received conventional extubation (£3949 [3430–4222] versus £4166 [3893–5603]; P<0.0001). Conclusions In adult patients undergoing surgery for congenital heart disease, EE is associated with a reduced need for postoperative hemodynamic support, a shorter intensive care unit stay, and lower health‐care‐related costs.https://www.ahajournals.org/doi/10.1161/JAHA.120.020201adult congenital heart diseasecardiac surgerycoarsened exact matchingearly extubationhealth economicshealth outcomes |
| spellingShingle | Paolo Bianchi Andrew Constantine Giulia Costola Sara Mele Darryl Shore Konstantinos Dimopoulos Tuan‐Chen Aw Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease adult congenital heart disease cardiac surgery coarsened exact matching early extubation health economics health outcomes |
| title | Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery |
| title_full | Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery |
| title_fullStr | Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery |
| title_full_unstemmed | Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery |
| title_short | Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery |
| title_sort | ultra fast track extubation in adult congenital heart surgery |
| topic | adult congenital heart disease cardiac surgery coarsened exact matching early extubation health economics health outcomes |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020201 |
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