Evidence-based Health Program, Federal University of Sao Paulo, Sao Paulo, Brazil.
Division of Vascular and Endovascular Surgery, Department of Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil.
BMJ Open. 2022 Apr 29;12(4):e054128. doi: 10.1136/bmjopen-2021-054128.
Congenital heart disease (CHD) comprises the anatomic malformations that jeopardise the structure and function of the heart. It can be extremely complex and serious, corresponding to 30% of all deaths in the first month of life. The surgical approach for adequate treatment requires postoperative mechanical ventilation. The most critical decision related to the postoperative management of patients submitted to cardiac surgery is the right time for extubation, especially because not only abrupt or inadequate discontinuation of ventilatory support can lead to clinical decline and necessity of reintubation but also extended time of mechanical ventilation, which can lead to complications, such as pneumonia, atelectasis, diaphragm hypertrophy, and increasing morbidity and mortality.
This systematic review plans to include individual parallel, cross-over and cluster randomised controlled trials regarding any breathing trial test to predict extubation success in children submitted to cardiac surgery due to CHD. Studies with paediatric patients submitted to cardiac surgery for congenital cardiopathy repair, attended at a critical care unit, and under mechanical ventilatory support will be included. The main outcomes analysed will be success of extubation, reduction of pulmonary complications and time reduction of mechanical ventilation.
We will not treat patients directly; therefore, ethics committee approval was not necessary because it is not a primary study. We expect that this study may improve healthcare and medical assistance, helping healthcare professionals with routine daily decisions regarding the correct time for extubation.
CRD42021223999.
先天性心脏病（CHD）包括危及心脏结构和功能的解剖畸形。它可能非常复杂和严重，占新生儿第一个月所有死亡人数的 30%。为了进行充分的治疗，手术方法需要术后机械通气。与心脏手术后患者的术后管理最相关的关键决策是拔管的正确时间，特别是因为不仅突然或不充分地停止通气支持可能导致临床恶化和需要重新插管，而且机械通气时间延长会导致肺炎、肺不张、膈肌肥大等并发症，并增加发病率和死亡率。
本系统评价计划纳入任何用于预测因先天性心脏病而接受心脏手术的儿童拔管成功的呼吸试验测试的个体平行、交叉和群组随机对照试验。将纳入在重症监护病房接受心脏手术修复先天性心脏病并接受机械通气支持的儿科患者的研究。分析的主要结果将是拔管的成功率、降低肺部并发症和机械通气时间的缩短。
我们不会直接治疗患者；因此，不需要伦理委员会批准，因为这不是一项主要研究。我们希望这项研究可以改善医疗保健和医疗援助，帮助医疗保健专业人员在日常决策中正确掌握拔管时间。
PROSPERO 注册号：CRD42021223999。
