Document Detail


Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery.
MedLine Citation:
PMID:  17040306     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Early extubation after cardiac surgery in children is feasible; however, predictors of prolonged mechanical ventilation (MV) should be recognized as soon as possible. METHODS: At a tertiary pediatric cardiac center, prospective case series analyses were carried out with a total of 411 patients within 1 year of cardiac surgery. Perioperative factors were evaluated for strength of association with duration of MV > 61 h (medium, MMV) and > 7 days (long, LMV). Two multiple regression models were performed for both cut-off points: one model considered factors identified until 24 h postoperation, the other was performed with all parameters. RESULTS: One hundred and three patients (25%) were still intubated after 61 h; 38 patients required LMV and they occupied 33% of total intensive care unit (ICU) bed days. If factors occurring until 24 h after surgery were analyzed, duration of cardiopulmonary bypass (CPB), intraoperative transfusion, post-CPB arterial oxygen tension (PaO2/FiO2), and fluid intake on the first day were found to be associated with MMV. Urea nitrogen value, nitric oxide treatment, delayed sternal closure, and tracheobronchomalacia, measured at the same point of time, were independent predictors of LMV. Of all the studied clinical predictors, MMV was associated with pulmonary hypertensive events, delayed sternal closure, peritoneal dialysis, nonvascular pulmonary problems, low output syndrome and fluid intake, while urea nitrogen (24 h), postsurgical neurological events, nitric oxide, tracheobronchomalacia, pulmonary hypertensive events and cardiac reoperations were identified as determinants of LMV. CONCLUSIONS: Causes of MV after surgery are heterogeneous, vary with time, and have variable impact on the duration of MV.
Authors:
Andrea Székely; Erzsébet Sápi; László Király; András Szatmári; Elek Dinya
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Paediatric anaesthesia     Volume:  16     ISSN:  1155-5645     ISO Abbreviation:  Paediatr Anaesth     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2006-10-16     Completed Date:  2007-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9206575     Medline TA:  Paediatr Anaesth     Country:  France    
Other Details:
Languages:  eng     Pagination:  1166-75     Citation Subset:  IM    
Affiliation:
Department of Paediatric Anaesthesia and Intensive Care, Gottsegen György National Institute of Cardiology, Budapest, Hungary. szekelya@kardio.hu
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures* / methods
Child
Child, Preschool
Forecasting
Heart Defects, Congenital / surgery,  therapy
Humans
Infant
Infant, Newborn
Intraoperative Period
Oxygen / blood
Postoperative Period
Prospective Studies
Regression Analysis
Respiration, Artificial / statistics & numerical data*
Risk Factors
Time Factors
Treatment Outcome
Ventilator Weaning / methods,  statistics & numerical data*
Ventilators, Mechanical / statistics & numerical data
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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