A Randomized Trial of Outcomes of Anesthetic Management Directed to Very Early Extubation After Cardiac Surgery in Children
A Randomized Trial of Outcomes of Anesthetic Management Directed to Very Early Extubation After Cardiac Surgery in Children
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DOI：
10.1053/j.jvca.2008.11.011
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发表时间：
2009-06-01
影响因子：
2.8
通讯作者：
Mishaly, David
中科院分区：
文献类型：
--
作者：
Preisman, Sergey;Lembersky, Henrietta;Mishaly, David
目的：针对心脏手术患儿早期拔管的术中处理已被认为是替代术后长时间机械通气的一种可行的方法。作者在一项随机前瞻性试验中评估了这种方法的安全性和有效性。设计：一项前瞻性随机观察研究。地点：一所大学附属医院。参与者：100名需要心脏手术的儿科患者(年龄1个月-15岁，体重3.0-51公斤)。1个月以下和手术前需要机械通气的患者被认为是不符合研究条件的。干预：患者被随机分为两组，一组在手术室进行麻醉管理并拔管(早期组)，一组选择性延长机械呼吸组(对照组[CG])。测量和主要结果：分析儿科重症监护病房(PICU)和住院时间、术后并发症和死亡率的差异。在3岁以下的儿童中进行了单独的分析。对照组拔管时间为25.0±26.9小时。两组之间的死亡率、再次探查出血的必要性、重新插管的必要性、异常胸片表现的发生率以及心脏和败血症并发症的发生率没有差异。两组患者术后住院天数和住院天数比较，两组差异有统计学意义(P<0.001)。结论：在心脏手术的患儿中，早期停止机械通气的麻醉管理是安全的，可以减少住院时间和术后住院天数。然而，由于这项研究的规模没有考虑到围手术期死亡率的可能差异，只有大型多中心研究才能为这个问题提供明确的答案。本研究可被视为此类试验的试点。(C)2009年，爱思唯尔公司出版。
Objectives: Intraoperative management directed to early extubation of children undergoing cardiac surgery has been suggested as a viable alternative to prolonged postoperative mechanical ventilation. The authors evaluated the safety and efficacy of this approach in a randomized prospective trial.Design: A prospective randomized observational study.Setting: A single university-affiliated hospital.Participants: One hundred consecutive pediatric patients (age 1 month-15 years, weight 3.0-51 kg) requiring cardiac surgery. Patients younger than 1 month of age and those requiring mechanical ventilation before the operation were considered ineligible for the study.Interventions: Patients were randomly allocated to a group with anesthetic management and extubation in the operating room (early group [EG]) and a group with elective prolonged mechanical ventilation (control group [CG]).Measurements and Main Results: A difference in outcome as reflected by the pediatric intensive care unit (PICU) and hospital lengths of stay and postoperative morbidity and mortality was analyzed. A separate analysis was performed in children younger than 3 years old. The extubation time in the CG was 25.0 +/- 26.9 hours. No differences in mortality, the need for re-exploration for bleeding, the need for reintubation, the incidence of abnormal chest radiographic findings, or cardiac and septic complications between groups were found. PICU and postoperative hospital lengths of stay were significantly shorter in patients in the EG (3.3 +/- 1.9 days in the EG v 5.8 +/- 4.1 in the CG, p < 0.001, and 7.4 +/- 2.9 days in the EG v 11.2 +/- 6.8 days in the CG, p = 0.009).Conclusions: In children undergoing cardiac surgery, anesthetic management with early cessation of mechanical ventilation appears to be safe and decreases hospital and PICU length of stay. However, because the size of the study did not allow for the detection of possible differences in perioperative mortality, only a large multicenter study may provide a definite answer to this question. The present study may be treated as a pilot for such a trial. (C) 2009 Published by Elsevier Inc.