Ultra‐Fast‐Track Extubation in Adult Congenital Heart Surgery
Autor: | Sara Mele, Giulia Costola, TC Aw, Andrew Constantine, Konstantinos Dimopoulos, Darryl F. Shore, Paolo Bianchi |
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Jazyk: | angličtina |
Rok vydání: | 2021 |
Předmět: |
Male
Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology coarsened exact matching law.invention 0302 clinical medicine law early extubation health economics health outcomes Postoperative Period 1102 Cardiorespiratory Medicine and Haematology Original Research Cardiovascular Surgery Quality and Outcomes propensity score matching Congenital Heart Disease Health Services Intensive care unit Cardiac surgery Costs and Cost Analysis Female Cardiology and Cardiovascular Medicine cardiac surgery Adult Heart Defects Congenital medicine.medical_specialty Critical Care 03 medical and health sciences medicine adult congenital heart disease Weaning Humans Diseases of the circulatory (Cardiovascular) system Ultra fast Cardiac Surgical Procedures Retrospective Studies Mechanical ventilation Cardiopulmonary Resuscitation and Emergency Cardiac Care Health economics business.industry Track (disk drive) Length of Stay 030228 respiratory system RC666-701 Propensity score matching Emergency medicine Airway Extubation Cost-Effectiveness business Follow-Up Studies |
Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 11 (2021) Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
ISSN: | 2047-9980 |
Popis: | 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 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 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. |
Databáze: | OpenAIRE |
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