A Clinical Study On The Effect Of Mechanical Ventilation Time On The Prognosis Of Children With Pulmonary Atresia Combined With Radical Resection Of Ventricular Septal Defect

Part ?.Risk factors for prolonged mechanical ventilation in patients after complete repair of pulmonary atresia with ventricular septal defectObjectives:rolonged mechanical ventilation(PMV)is a common complication in patients after complete repair of pulmonary atresia and ventricular septum defect(PA/VSD).We aimed to identify the risk factors for PMV following PA/VSD surgery.Methods:We retrospectively analyzed a cohort of 220 patients who undergoing complete repair surgery of PA/VSD from 2011 to 2018.PMV was defined as failure to wean from mechanical ventilation more than 5 days postoperatively.Univariate analysis,logistic regression analysis and receiver operating characteristic curve were used to identify independent risk factors for PMV.The impacts of PMV on the short-term outcomes were also evaluated.Results:PMV occurred in 39.1%of patients in our cohort.The independent risk factors for PMV were identified as longer duration of cardiopulmonary bypass(CPB)(OR,2.51,95%CI,1.33-4.71,P=0.004),postoperative occlusion of collateral vessels(OR,8.06,95%CI,1.94-33.40,P=0.004)and abnormal preoperative leukocytes counts(OR,2.44,95%CI,1.30-4.58,P=0.005).Fast-track anesthesia(OR,0.10,95%CI,0.01-0.86,P=0.038)was significantly associated with a lower risk of PMV.The area under ROC(AUC)for the final logistic model was 0.72(95%CI,0.65-0.79,P<0.001).Patients with PMV were associated with increased in-hospital mortality,pulmonary complications,re-intubation,renal replacement therapy and other infectious complications.Conclusions:Based on our experience,longer duration of CPB,postoperative occlusion of collateral vessels,abnormal preoperative leukocytes count and without fast-track anesthesia were identified as independent risk factors for PMV.Adopting a comprehensive strategy of preoperative assessment of inflammation status and perioperative management targeting on the standard to occlude the collateral vessels might significantly lower the risk of PMV and improve in-hospital outcomes.Part ?.Early extubation is associated with improved outcomes after complete surgical repair of pulmonary atresia with ventricular septal defect in pediatric patientsBackground:The aim of this study was to investigate the impact of an early extubation strategy on outcomes following complete repair of pulmonary atresia,ventricular septal defect,and hypoplastic pulmonary artery.Methods:113 patients undergoing complete repair surgery of pulmonary atresia,ventricular septal defect,and hypoplastic pulmonary artery between 2016 and 2018 were included in our retrospective propensity-score matched study.Propensity score matching was conducted in 1 to 2 ratio to balance the covariables impacting on clinical outcomes between groups.The primary outcomes were defined as length of intensive care unit stay,postoperative length of hospital stay and in-hospital medical cost.The secondary outcomes included postoperative complications such as re-intubation,re-exploration,in-hospital mortality,arrhythmia and etc.In addition,blood product consumption was also abstracted.Results:Compared with matched controls,patients in the early extubation group were demonstrated with a significant reduced length of intensive care unit stay(Median:1.9 d vs.4.1 d,p=0.039),postoperative length of hospital stay(Median:9.0 d vs.17.0 d,p=0.007)and in-hospital medical cost(Median:69.5×1000CNY vs.113.6×1000CNY,p=0.041).As for the postoperative complications,the occurrence of re-intubation,re-exploration,in-hospital mortality,arrhythmia and renal replacement therapy was similar between groups.However,pulmonary complications(p=0.049)were with a significantly lower rate in the early extubation group.In addition,fresh frozen plasma(p=0.041)transfusion volume were significantly reduced in the early extubation group rather than packed red blood cells and platelets.Conclusions:Early extubation following complete repair of pulmonary atresia improved clinical outcomes and reduced in-hospital medical cost without increasing any postoperative complications.Review.Enhanced recovery after surgery in pediatric patients undergoing cardiac surgery:a review of literaturesIn the past decades,both short-and long-term outcomes of patients after surgeries have been improved remarkably,with the development in surgical techniques and perioperative management strategies.In recent years,the emergence of enhanced revocery after surgery(ERAS)has been reforming the philosophy of perioperative staff,which makes further efforts to improve prognosis of patients after surgeries.However,pediatric patients have distinguished pathophysiological process and social-economic-psycological status from adults,which will result in relatively worse compliance of strategies for adults'patients.Our study will review the results of researches,experience of clinical practice,and ERAS guidelines in pediatrics undergoing non-cardic surgeries or adults undergoing cardiac surgeries,eventually summarizing the ERAS bundles in pediatric patients undergoing cardiac surgery.As a consequence,we believe this review is expected to play an important role in promoting ERAS bundles in pediatric patients undergoing cardiac surgeries in China.