Our Summary

This research paper looks at differences in how soon children are taken off breathing machines (extubated) after heart surgery, and where this happens - either in the operating room or in the intensive care unit (ICU). Using data from 28 hospitals over about three and a half years, the researchers examined over 16,000 surgeries. They found that how quickly and where extubation happens varies greatly from hospital to hospital. They divided the hospitals into three groups: those where less than half of the early extubations happened in the operating room, those where between half and 90% did, and those where more than 90% did. They found that the amount of time children spent in the hospital after surgery did not significantly differ between these groups. However, hospitals that often extubated in the operating room used noninvasive ventilation (like masks instead of tubes) more often and had fewer instances where they had to put the child back on a breathing machine. The research suggests that the practice of early extubation and its location does not significantly affect the length of hospital stay after pediatric cardiac surgery.

FAQs

  1. What was the main focus of this research on pediatric cardiac surgery?
  2. How did the practice of early extubation vary from hospital to hospital?
  3. Did the location of early extubation and its practice have an effect on the length of the child’s hospital stay after cardiac surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric cardiac surgery is to ask about the hospital’s protocol for extubation after surgery. Understanding where and how quickly the child will be taken off the breathing machine can help set expectations and potentially improve outcomes. It may also be beneficial to inquire about the hospital’s use of noninvasive ventilation methods, as this could potentially reduce the need for reintubation.

Suitable For

Patients who may be recommended pediatric cardiac surgery include those with congenital heart defects, acquired heart diseases, and other cardiac abnormalities. These patients may range in age from newborns to adolescents. Some specific conditions that may require pediatric cardiac surgery include:

  1. Tetralogy of Fallot
  2. Transposition of the great arteries
  3. Atrial septal defect
  4. Ventricular septal defect
  5. Coarctation of the aorta
  6. Hypoplastic left heart syndrome
  7. Aortic valve stenosis
  8. Pulmonary valve stenosis
  9. Ebstein’s anomaly
  10. Cardiomyopathy

It is important for patients with these conditions to be evaluated by a pediatric cardiologist and a pediatric cardiac surgeon to determine the appropriate treatment plan, which may include surgical intervention. Additionally, patients with complex or high-risk conditions may be referred to specialized centers or pediatric cardiac surgery programs for optimal care.

Timeline

Before pediatric cardiac surgery:

  1. Consultation with pediatric cardiologist to discuss the need for surgery and potential risks and benefits.
  2. Preoperative testing such as blood tests, imaging scans, and electrocardiogram.
  3. Admission to the hospital for surgery, with preoperative preparation including fasting and medication administration.
  4. Anesthesia induction in the operating room before the surgery begins.
  5. Pediatric cardiac surgery performed by the cardiac surgical team, which may involve repairing or replacing heart valves, correcting congenital heart defects, or performing a heart transplant.
  6. Extubation either in the operating room or in the ICU, depending on hospital practices and the child’s condition.

After pediatric cardiac surgery:

  1. Postoperative care in the ICU, including monitoring of vital signs, pain management, and respiratory support.
  2. Gradual weaning off of breathing machines and other medical devices as the child’s condition improves.
  3. Physical therapy and rehabilitation to help the child regain strength and mobility.
  4. Discharge from the hospital once the child is stable and able to continue recovery at home.
  5. Follow-up appointments with the pediatric cardiologist to monitor the child’s progress and adjust treatment as needed.
  6. Long-term management of the heart condition through medications, lifestyle changes, and regular check-ups to prevent future complications.

What to Ask Your Doctor

  1. What is the likelihood of my child needing to be placed back on a breathing machine after extubation?
  2. What are the potential risks and benefits of early extubation in the operating room versus in the intensive care unit?
  3. How does the hospital’s practice of early extubation and location of extubation impact the overall outcome of pediatric cardiac surgery?
  4. Are there any specific criteria that need to be met in order for my child to be considered for early extubation in the operating room?
  5. How does the hospital’s experience and expertise in pediatric cardiac surgery play a role in the decision-making process regarding early extubation?
  6. What measures are in place to ensure the safety and well-being of my child during the extubation process, regardless of location?
  7. How does the hospital’s use of noninvasive ventilation techniques impact the recovery and outcome of pediatric cardiac surgery patients?
  8. Are there any potential long-term effects or complications associated with early extubation in the operating room versus in the intensive care unit?
  9. What support and resources are available for families during the decision-making process and recovery period following pediatric cardiac surgery?
  10. How can I best advocate for my child and ensure they receive the highest quality care during their journey through pediatric cardiac surgery and recovery?

Reference

Authors: Rooney SR, Mastropietro CW, Benneyworth B, Graham EM, Klugman D, Costello J, Ghanayem N, Zhang W, Banerjee M, Gaies M. Journal: Pediatr Crit Care Med. 2020 Oct;21(10):e915-e921. doi: 10.1097/PCC.0000000000002452. PMID: 32639473