Perioperative factors affecting fast tracking in paediatrics cardiac surgical patients
Background: Preoperative and intraoperative factors that influence the postoperative period including weaning time from mechanical ventilation and extubation: in a paediatric cardiac patients have been widely studied with contradicting reports and variation from centre to centre. The aim of this study was to determine factors that influence the duration of weaning in paediatric cardiac surgical patients and their associated complications at our centre.
Methods: This was a prospective study that recruited all eligible paediatric patients from infancy to childhood whom underwent cardiac surgical repair at Care Hospital Hyderabad, India between January and June 2007.Excluded were old age more than 18 years or patient with cardiac lesion undergoing palliative operation other than those involving cardiopulmonary bypass. Patients` demographic data including age, sex, height, weight and consequently body surface area were retrieved from patients` record file. The duration of symptoms was also determined and reported in months. Patients’ diagnoses details of the nature of the cardiac lesion as reported from echocardiography and or cardiac catheterization was recorded. Intraoperative parameters including the type of cardiac operation were taken care and recorded accordingly. Patient was followed up postoperatively both in the intensive care unit and in the general ward while closely monitored noting for any complications till the patient was discharged from either of these units. Patients’ data were entered into a master sheet data and later into a SPSS.11.5 window program for analyses using χ2-test for categorical data.
Results: There were 103 patients of which 60.2% and 39.8% were male and female respectively. The mean age was 74.45 months: mean duration of symptoms was 54.52 months. Majority of patients had congenital heart disease that accounted for 93.6% of all cases while chronic rheumatic heart disease was found in 6.8% of cases. Tetrallogy of fallot and ventricular septal defect were the commonest among congenital heart disease representing 27.2% and 25.2% respectively. Young age was found to be a factor associated with prolonged mechanical ventilation and extubation. Further, the presence of pulmonary hypertension, lower cardiac grade and ventricular dysfunction were found to be factors significantly associated with prolonged weaning. While, cardiac disease occurring in combination, ischemia time, duration of cardiopulmonary bypass, total operation time, left ventricular ejection fraction, pH at the end of cardiopulmonary bypass and preoperative hemoglobin were factors found not to be associated with prolonged weaning.
Conclusion: Our study has shown that presence of pulmonary hypertension, cardiac grade and ventricular dysfunction were factors associated with prolonged time to weaning. While aortic cross-clamp, total duration of cardiopulmonary bypass, , cardiac disease occurring in combination, total operation time and level of hemoglobin were not associated with prolonged time to weaning.