Early extubation in congenital heart surgery.

BACKGROUND

The concept of early extubation following congenital heart surgery is not new. Changes in health care have generated increasing interest in this technique. Some of the problems following surgery are related to the endotracheal tube and mechanical ventilation, and the interventions necessary to maintain them.

METHODS

To evaluate the impact of early extubation (within 6 h postoperatively) on children undergoing congenital heart surgery, retrospective data were obtained from records of 1000 consecutive patients.

RESULTS

Early extubation occurred in 80.2% of patients (73% in the operating room). Early extubation was not limited to simple anomalies; it was also possible for complex anomalies such as Fallot's tetralogy (including those patients with pulmonary atresia, absent pulmonary valve and complete atrioventricular septal defects; n =106), where 91% of patients had early extubation, and Fontan operations (n =17), where 88% did. There were no deaths related to early extubation. Preoperative intubation was a risk factor for postoperative ventilation. As expected, the patients requiring ventilation after surgery were younger, smaller and more critically ill than those that met the criteria for early extubation.

CONCLUSIONS

A change in attitude combined with appropriate anaesthetic and surgical techniques permitted safe, early extubation in a large number of patients. Patient populations vary between institutions. Early extubation is not always possible, but for those patients in whom it is feasible, the benefits include simplified postoperative care and increased patient and family satisfaction. When combined with clinical practice guidelines, it can result in a significant reduction in the cost of patient care after cardiac surgery.