Early extubation following open heart surgery in pediatric patients with congenital heart diseases.

The study of tracheal extubation time in pediatric patients who underwent open heart surgery was performed in the period of 1990-1991 (group 1) and 1992-May 1994 (group 2), composed of 174 and 208 cases in group 1 and group 2 respectively. The criteria for extubation in these patients are convention regimens with considered subsequent standard of CPB, such as fully rewarmed, hemodynamic stable with adequate cardiac output with low-dose or no inotropes/ vasodilator, without significant dysrhythmias and no significant mediastinal bleeding. The difference of postoperative fluid management between the two groups include the regimens of total fluid intake of two-thirds of daily maintenance fluid in group 1, whereas, the total fluid therapy of group 2 depended on the patients' age and body weight. The results show that, early extubation within 8 hours of ICU arrival were 20.5 per cent and 61.7 per cent in group 1 and group 2 respectively. All of the patients in group 2, after extubation, were discharged to the ward on the first postoperative day. The overnight ventilation was about 74.1 per cent and 30.6 per cent in the first and second groups respectively. The prolonged intubation (more than 24 hours) was almost the same in two groups. There was no significant complication of early extubation with the limitation of daily total fluid intake. The causes of tracheal reintubation in both groups were fluid overload and residual cardiac lesions. The prior etiology occurred in group 1 more than group 2. It was concluded that, after the change in postoperative fluid therapy regimens, early extubation following open-heart pediatric surgery is highly successful with no significant complication. The benefits of early extubation include cost savings, patient comfort, early patient mobilization, improved cardiac function, reduced respiratory complications and reduction of case cancellation due to early ICU discharge.