Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia.

Details

Serval ID
serval:BIB_6324C8701341
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia.
Journal
Intensive care medicine
Author(s)
Fischer J.E., Allen P., Fanconi S.
ISSN
0342-4642
Publication state
Published
Issued date
2000
Peer-reviewed
Oui
Volume
26
Number
7
Pages
942-9
Language
english
Notes
Publication types: Journal Article - Publication Status: ppublish
Abstract
OBJECTIVE: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children. METHODS: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation. RESULTS: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6%). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6%), and the need for secondary surgery (n = 51, 18.8%; e.g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95% CI 0.18-0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50). CONCLUSION: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
Keywords
Analysis of Variance, Cardiac Surgical Procedures, Female, Humans, Infant, Infant, Newborn, Intensive Care Units, Pediatric, Male, Pneumonia, Postoperative Complications, Proportional Hazards Models, Respiration, Artificial, Retrospective Studies, Risk Factors, Switzerland, Time Factors
Pubmed
Web of science
Create date
25/01/2008 10:07
Last modification date
20/08/2019 14:19
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