Baehner Torsten, Pruemm Philipp, Vergnat Mathieu, Asfour Boulos, Straßberger-Nerschbach Nadine, Kirfel Andrea, Hamann Michael, Mayr Andreas, Schindler Ehrenfried, Velten Markus, Wittmann Maria
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Department of Anesthesiology and Intensive Care Medicine, Stiftshospital Andernach, 56626 Andernach, Germany.
J Clin Med. 2022 Sep 1;11(17):5186. doi: 10.3390/jcm11175186.
Background: Enhanced recovery after surgery (ERAS) protocols are utilizing a multidisciplinary approach, reassessing physiology to improve clinical outcomes, reducing length of hospital stay (LOS) stay, resulting in cost reduction. Since its introduction in colorectal surgery. the concept has been utilized in various fields and benefits have been recognized also in adult cardiac surgery. However, ERAS concepts in pediatric cardiac surgery are not yet widely established. Therefore, the aim of the present study was to assess the effects of on-table extubation (OTE) after pediatric cardiac surgery compared to the standard approach of delayed extubation (DET) during intensive care treatment. Study Design and Methods: We performed a retrospective analysis of all pediatric cardiac surgery cases performed in children below the age of two years using cardiopulmonary bypass at our institution in 2021. Exclusion criteria were emergency and off pump surgeries as well as children already ventilated preoperatively. Results: OTE children were older (267.3 days vs. 126.7 days, p < 0.001), had a higher body weight (7.0 ± 1.6 kg vs. 4.9 ± 1.9 kg, p < 0.001), showed significantly reduced duration of ICU treatment (75.9 ± 56.8 h vs. 217.2 ± 211.4 h, p < 0.001) and LOS (11.1 ± 10.2 days vs. 20.1 ± 23.4 days; p = 0.001) compared to DET group. Furthermore, OTE children had significantly fewer catecholamine dependencies at 12-, 24-, 48-, and 72-h post-surgery, while DET children showed a significantly increased intrafluid shift relative to body weight (109.1 ± 82.0 mL/kg body weight vs. 63.0 ± 63.0 mL/kg body weight, p < 0.001). After propensity score matching considering age, weight, bypass duration, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Mortality (STATS)-Score, and the outcome variables, including duration of ICU treatment, catecholamine dependencies, and hospital LOS, findings significantly favored the OTE group. Conclusion: Our results suggest that on-table extubation after pediatric cardiac surgery is feasible and in our cohort was associated with a favorable postoperative course.
术后加速康复（ERAS）方案采用多学科方法，重新评估生理机能以改善临床结局，缩短住院时间（LOS），从而降低成本。自其在结直肠手术中引入以来，这一概念已在各个领域得到应用，在成人心脏手术中也已认识到其益处。然而，小儿心脏手术中的ERAS概念尚未广泛确立。因此，本研究的目的是评估小儿心脏手术后术中拔管（OTE）与重症监护治疗期间延迟拔管（DET）的标准方法相比的效果。
我们对2021年在我院接受体外循环的2岁以下儿童的所有小儿心脏手术病例进行了回顾性分析。排除标准为急诊手术、非体外循环手术以及术前已进行机械通气的儿童。
与DET组相比，OTE组儿童年龄更大（267.3天 vs. 126.7天，p < 0.001），体重更高（7.0±1.6 kg vs. 4.9±1.9 kg，p < 0.001），ICU治疗时间显著缩短（75.9±56.8小时 vs. 217.2±211.4小时，p < 0.001），住院时间也显著缩短（11.1±10.2天 vs. 20.1±23.4天；p = 0.001）。此外，OTE组儿童术后12小时、24小时、48小时和72小时的儿茶酚胺依赖显著减少，而DET组儿童相对于体重的体液内转移显著增加（109.1±82.0 mL/kg体重 vs. 63.0±63.0 mL/kg体重，p < 0.001）。在考虑年龄、体重、体外循环时间、胸外科医师协会-欧洲心胸外科协会死亡率（STATS）评分以及包括ICU治疗时间、儿茶酚胺依赖和住院时间在内的结局变量进行倾向评分匹配后，结果显著有利于OTE组。
我们的结果表明，小儿心脏手术后术中拔管是可行的，在我们的队列中与良好的术后病程相关。
