Key result
Fast-track extubation in pediatric CHD linked to shorter intubation times without increasing postoperative complications.
Why the study?
Low-dose, short-acting anesthetic agents may enable faster postoperative recovery and reduce mechanical ventilation need in pediatric congenital heart surgery, but evidence is mostly retrospective.
Does a fast-track extubation protocol reduce intubation and ventilator times in pediatric patients undergoing congenital cardiac surgery in developing countries?
Observational (n=91)
Does a fast-track extubation protocol reduce intubation and ventilator times in pediatric patients undergoing congenital cardiac surgery in developing countries?
Fast-track extubation protocols (< 4 hours) are safe and effective for pediatric patients undergoing congenital cardiac surgery in developing countries.
May support fast-track extubation in resource-limited pediatric cardiac surgery; leaves open need for randomized confirmation.
Objective In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. Methods There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, and no active bleeding. In this setting, a careful choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. Results The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing postoperative complications in pediatric congenital heart disease. Conclusion This study supports a wider use of fast-track extubation protocols in pediatric patients submitted for congenital cardiac surgery in developing countries.
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Iezzi et al. (2017) conducted an observational in Congenital heart disease (n=91). Fast-track extubation protocol was evaluated on Success rate of fast-track approach (early extubation < 4 hours). In 91 pediatric patients with congenital heart disease, a fast-track extubation protocol (< 4 hours) was effective and safe, reducing intubation times without increasing postoperative complications.
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