Shinkawa Takeshi, Tang Xinyu, Gossett Jeffrey M, Dasgupta Rahul, Schmitz Michael L, Gupta Punkaj, Imamura Michiaki
1 Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
2 Biostatistics Program, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):529-536. doi: 10.1177/2150135118779010.
The objectives were to assess the incidence of immediate tracheal extubation in the operating room after pediatric cardiac surgery and to investigate predictors for subsequent reintubation.
This is a single institutional retrospective study including all patients who had a cardiac operation with cardiopulmonary bypass from 2011 to 2016. Patients who required preoperative ventilator support, postoperative open chest, or mechanical support were excluded. Predictors for reintubation after immediate extubation were analyzed only for patients with stage II palliation for single ventricle physiology.
Nine hundred nine qualifying operations were identified. Immediate extubation was performed in 590 (64.9%) operations. A multivariable logistic regression model showed that the identities of anesthesiologist ( P = .0003), year of the operation performed ( P < .001), cardiopulmonary bypass time ( P < .001), and type of operations ( P < .001) were significantly associated with immediate extubation. Reintubation was significantly less frequent in patients with immediate extubation compared to those without (6.1% vs 15.0%; P < .001). A subgroup analysis for stage II palliation showed that reintubation after immediate extubation was significant for younger age (0.42 vs 0.54 years, P = .044), lower Po/Fio and Po at the last blood gas analysis (66 vs 98 mm Hg, P = .032 and 39 vs 47 mm Hg, P = .008), and higher inotropic score (2 vs 0, P = .034). A multivariable logistic regression model showed that only inotropic score was significantly associated with reintubation ( P = .018).
Immediate extubation in the operating room after pediatric cardiac surgery can be performed in most patients. Inotropic score is a predictor for reintubation in stage II palliation.
评估小儿心脏手术后在手术室即刻气管拔管的发生率，并调查后续再次插管的预测因素。
这是一项单机构回顾性研究，纳入了2011年至2016年期间所有接受体外循环心脏手术的患者。排除术前需要呼吸机支持、术后开胸或机械支持的患者。仅对单心室生理状态II期姑息治疗的患者分析即刻拔管后再次插管的预测因素。
共确定了909例符合条件的手术。590例（64.9%）手术进行了即刻拔管。多变量逻辑回归模型显示，麻醉医生的身份（P = 0.0003）、手术年份（P < 0.001）、体外循环时间（P < 0.001）和手术类型（P < 0.001）与即刻拔管显著相关。与未即刻拔管的患者相比，即刻拔管的患者再次插管的频率显著更低（6.1%对15.0%；P < 0.001）。II期姑息治疗的亚组分析显示，即刻拔管后再次插管在年龄较小（0.42对0.54岁，P = 0.044）、最后一次血气分析时较低的氧分压/吸入氧浓度比值和氧分压（66对98 mmHg，P = 0.032和39对47 mmHg，P = 0.008）以及较高的血管活性药物评分（2对0，P = 0.034）的患者中更显著。多变量逻辑回归模型显示，只有血管活性药物评分与再次插管显著相关（P = 0.018）。
大多数小儿心脏手术后的患者可在手术室进行即刻拔管。血管活性药物评分是II期姑息治疗中再次插管的预测因素。
