Figueroa-Solano Javier, Infante-Sánchez Karen, Espinosa-Guerra Kenia, Astudillo-De Haro Esteban David, Martínez-Albarenga Paola María, Lesprón-Robles Ma Del Carmen, Molina-Méndez Francisco Javier, Miranda-Chávez Irma Ofelia
Department of Pediatric Cardiovascular Intensive Care, National Institute of Cardiology, Ignacio Chávez, Mexico City, Mexico.
Department of Postoperative Care, XXI Century National Medical Center, Mexican Social Security Institute, Hospital of Cardiology, Mexico City, Mexico.
J Pediatr Intensive Care. 2022 Feb 21;13(4):337-343. doi: 10.1055/s-0042-1743177. eCollection 2024 Dec.
Early extubation (EE) in pediatric cardiac surgery has demonstrated important benefits. However, ventilating them for 24 hours or more (delayed decannulation, DD) is an enduring practice. The objectives of this study were to describe the clinical profiles of EE in our setting and analyze its impact and the factors that prolong mechanical ventilation. Children operated on for cardiac surgery from 2016 to 2017 were included. Data were obtained from an electronic database. Comparisons were performed with Pearson's chi-square test, Student's -test, or Mann-Whitney U test. Multivariate logistic regression was used to evaluate factors associated with DD. Of 649 cases, 530 were extubated on one occasion. EE was performed in 305 children (57.5%): 97 (31.8%) in the operating room and 208 (68.2%) in the intensive care unit (ICU). Reintubation (RI) occurred in 7.5% with EE and 16.9% with DD ( = 0.001). Fewer complications and ventilation time and decreased ICU and hospital length of stay resulted with EE. Age, presurgical ventilation, emergency surgery, pump time, attempts to weaning from cardiopulmonary bypass, bleeding greater than usual, and CPR in surgery were associated with DD. EE in the National Institute of Cardiology (INC; Spanish acronym) is in the middle category and has shown benefits without compromising the patient; the fear of further complications, RI, or death is unfounded. Although not all children at the INC can be decannulated early, if there are no or minimal risk factors, it should be a priority.
小儿心脏手术中的早期拔管（EE）已显示出重要益处。然而，对他们进行24小时或更长时间的通气（延迟拔管，DD）仍是一种长期做法。本研究的目的是描述我们医院中EE的临床特征，分析其影响以及延长机械通气的因素。纳入了2016年至2017年接受心脏手术的儿童。数据从电子数据库中获取。采用Pearson卡方检验、Student's t检验或Mann-Whitney U检验进行比较。使用多因素逻辑回归评估与DD相关的因素。在649例病例中，530例一次拔管。305名儿童（57.5%）进行了EE：97例（31.8%）在手术室，208例（68.2%）在重症监护病房（ICU）。EE组再插管（RI）发生率为7.5%，DD组为16.9%（P = 0.001）。EE导致并发症和通气时间减少，ICU和住院时间缩短。年龄、术前通气、急诊手术、体外循环时间、脱离体外循环的尝试次数、出血多于平常以及手术中的心肺复苏与DD相关。国立心脏病学研究所（INC；西班牙语缩写）的EE处于中等水平，已显示出益处且不影响患者；对进一步并发症、RI或死亡的恐惧是没有根据的。虽然并非所有在INC的儿童都能早期拔管，但如果没有或仅有极少风险因素，应将其作为优先事项。
