Reducing ventilation duration after congenital cardiac surgery does not increase re-intubation, and shortens ICU length of stay

Abstract

Aims & Objectives: The duration of ventilation after congenital cardiac surgery (CCS) may be related to morbidity, length of ICU and hospital stay. We introduced a protocol for early extubation after CCS, and evaluated whether duration of ventilation can be reduced, and the effects of such an intervention on re-intubation rates, and length of ICU and hospital stay. Methods All patients treated in our institution between December 2014 and June 2017 were evaluated. The “early extubation protocol” was started in June 2016. Exclusion criteriae were: Norwood procedures, pulmonary artery bands, systemic to pulmonary artery shunts, and post-operative open chest. Results 560 patients were identified. 249 were treated before, and 311 after protocol implementation. The proportion of extubated patients was 37.2% vs. 48.4% at 12, 42% vs. 52.0% at 16 and 73.2% vs. 82% at 24 hours (p<0.02, before/after protocol implementation). The maximum rate of extubation after protocol occurred around 4.6 hours, at which time 26.3% vs. 14.0% (p=0.001) were extubated after vs before protocol implementation (odds ratio 2.2). No significant differences existed between the two group regarding age, weight, sex, type of congenital heart disease, bypass time, cross clamp time, or aristotle score. Median ICU and hospital stay (days) were 1.98 vs 1.84 (p=0.002) and 11.08 vs 11.19 (p=0.313) for the two groups. Re-intubation rates were 7.4% vs 6.5% before and after protocol implementation (p=0.7). Conclusions Reduction of ventilation time after CCS can be achieved easily without increasing re-intubation rates. Reduction of ventilation was associated with a shorter length of stay in ICU.L6238154742018-09-13 <br />