Székely Andrea, Sápi Erzsébet, Király László, Szatmári András, Dinya Elek
Department of Paediatric Anaesthesia and Intensive Care, Gottsegen György National Institute of Cardiology, Budapest, Hungary.
Paediatr Anaesth. 2006 Nov;16(11):1166-75. doi: 10.1111/j.1460-9592.2006.01957.x.
Early extubation after cardiac surgery in children is feasible; however, predictors of prolonged mechanical ventilation (MV) should be recognized as soon as possible.
At a tertiary pediatric cardiac center, prospective case series analyses were carried out with a total of 411 patients within 1 year of cardiac surgery. Perioperative factors were evaluated for strength of association with duration of MV > 61 h (medium, MMV) and > 7 days (long, LMV). Two multiple regression models were performed for both cut-off points: one model considered factors identified until 24 h postoperation, the other was performed with all parameters.
One hundred and three patients (25%) were still intubated after 61 h; 38 patients required LMV and they occupied 33% of total intensive care unit (ICU) bed days. If factors occurring until 24 h after surgery were analyzed, duration of cardiopulmonary bypass (CPB), intraoperative transfusion, post-CPB arterial oxygen tension (PaO2/FiO2), and fluid intake on the first day were found to be associated with MMV. Urea nitrogen value, nitric oxide treatment, delayed sternal closure, and tracheobronchomalacia, measured at the same point of time, were independent predictors of LMV. Of all the studied clinical predictors, MMV was associated with pulmonary hypertensive events, delayed sternal closure, peritoneal dialysis, nonvascular pulmonary problems, low output syndrome and fluid intake, while urea nitrogen (24 h), postsurgical neurological events, nitric oxide, tracheobronchomalacia, pulmonary hypertensive events and cardiac reoperations were identified as determinants of LMV.
Causes of MV after surgery are heterogeneous, vary with time, and have variable impact on the duration of MV.
儿童心脏手术后早期拔管是可行的；然而，应尽快识别出延长机械通气（MV）时间的预测因素。
在一家三级儿科心脏中心，对心脏手术后1年内的411例患者进行了前瞻性病例系列分析。评估围手术期因素与MV持续时间>61小时（中等，MMV）和>7天（长，LMV）的关联强度。针对两个截断点分别进行了两个多元回归模型：一个模型考虑术后24小时内确定的因素，另一个模型纳入所有参数。
103例患者（25%）在61小时后仍需插管；38例患者需要长时间MV，他们占用了重症监护病房（ICU）总床日数的33%。如果分析术后24小时内出现的因素，发现体外循环（CPB）持续时间、术中输血、CPB后动脉血氧分压（PaO2/FiO2）和第一天的液体摄入量与MMV相关。在同一时间点测量的尿素氮值、一氧化氮治疗、延迟胸骨闭合和气管软化是LMV的独立预测因素。在所有研究的临床预测因素中，MMV与肺动脉高压事件、延迟胸骨闭合、腹膜透析、非血管性肺部问题、低心排血量综合征和液体摄入量相关，而尿素氮（24小时）、术后神经系统事件、一氧化氮、气管软化、肺动脉高压事件和心脏再次手术被确定为LMV的决定因素。
术后MV的原因是多方面的，随时间变化，对MV持续时间的影响也各不相同。
