1995 OPEN FORUM Abstracts
Length Of Mechanical Ventilation Following Surgery For Congenital Heart Disease
Barbara G. Wilson RRT, Cecelia Kuyper MD, Ira Cheifetz MD, Frank Kern MD, Jon N. Meliones MD. Duke University Medical Center, Durham, NC
Outcome data is essential in the assessment of critical care program quality and performance. Length of mechanical ventilation (LMV), length of ICU stay (LOS), and extubation failures (EF)are major contributors to cost and risk associated with critical respiratory care. We monitored these parameters to establish respiratory care benchmarks for pediatric patients who have undergone surgery for congenital heart disease (CHD). A summary of this data is presented. Method: 43 consecutive CHD patients, intubated and ventilated post-operatively, were reviewed retrospectively. Patients ventilated hours were excluded. Body weights ranged from 3.0 - 8.0 Kgs. Ages ranged from 1 week to 16 months. 7 diagnostic groups were identified: AVSD, TOF, TGA, VSD, LOB, PA and Other. LMV was the total time on the ventilator to successful extubation. LOS was the time from post-op admission to ICU discharge. EF constituted reintubation within 24 hours of elective extubation. Results are reported as the mean value ± SD. Unpaired t-test and ANOVA were used to assess intra-group differences. A p<.05 was considered significant.
HoursAll CHD Extubation Failures (7/43,16%)
LMV81 ± 76206 ± 109*
LOS 129 ± 100 282 ± 109**
HOURAVSD TOFTGA VSDLOBPA OTHER
LMV 44±25 82±52165±14275±45244±106* 70±35 46±54
LOS 70±48138±101 213±158 128±87316±110* 141±3975±77
(AVSD=AV canal, TOF=tetrology of Fallot, TGA=Transposition of Great
Ateries, VSD=Ventricular Septal Defect, LOB=Left sided obstructive lesions,
Results: LMV was less than previously reported(1). Patients who failed extubation had significant increases in LMV (p=.0006)* and LOS(p=.0007)** and were isolated to high risk CHD anomalies. Patients increased LMV and LOS (p < .05)*.
Conclusions: High risk CHD diagnoses (LOB group) should be targeted for interventional strategies to reduce length of mechanical ventilation, ICU length of stay, and extubation failure.
1. Chatburn RL, Blumer JL. RC 1994(39)11:1060.