Effects of on-table extubation on resource utilization and maternal anxiety in children undergoing congenital heart surgery in a low-resource environment.

IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Annals of Pediatric Cardiology Pub Date : 2023-11-01 Epub Date: 2024-04-23 DOI:10.4103/apc.apc_162_23
Kaushik Jothinath, Vijayakumar Raju, Michael E Nemergut, Grace M Arteaga, Pavithra Ramanath, Thirumalaisamy Vijayalakshmi
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引用次数: 0

Abstract

Objective: To study the applicability of on-table extubation (OTE) protocol following congenital cardiac surgery in a low-resource setting and its impact on the length of intensive care unit (ICU) stay, hospital stay, hospitalization cost, parental anxiety, and nurse anxiety.

Materials and methods: In this prospective, nonrandomized, observational single-center study, we included all children above 1 year of age undergoing congenital cardiac surgery. We evaluated them for the feasibility of OTE using a prespecified protocol following separation from cardiopulmonary bypass. The data were prospectively collected on 60 children more than 1 year of age, belonging to the Risk Adjustment for Congenital Heart Surgery 1, 2, 3, and 4 groups and divided into two groups: those who underwent successful OTE and those who were ventilated for any duration postoperatively (30 children in each group). Duration of hospital stay, ICU stay, and total hospital cost were collected. Anxiety levels of the primary caregiver (nurse) in the ICU and the mother were assessed immediately after the arrival of the child in the ICU using the State Trait Anxiety Inventory (STAI).

Results: Children who were extubated immediately following congenital cardiac surgery had significantly shorter ICU stay (median 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05]). Patients extubated on table had a significant reduction in hospital cost {median Rs. 161,000 (138,330; 211,900), approximately USD 1970 (P < 0.05)} when compared to children who were ventilated postoperatively {median Rs. 201,422 (151,211; 211,900) , approximately USD 2464}. The anxiety level in mothers was significantly less when their child was extubated in the operating room (STAI 36.5 ± 5.4 vs. 47.4 ± 7.4, P < 0.001). However, for the same subset of patients, anxiety level was significantly higher in the ICU nurse (STAI 46.0 ± 5.6 vs. 37.8 ± 4.1, P < 0.05).

Conclusion: OTE following congenital cardiac surgery is associated with a shorter duration of ICU stay and hospital stay. It also reduces the total hospital cost and the anxiety level in mothers of children undergoing congenital heart surgery. However, the primary bedside caregiver during the child's ICU stay had increased anxiety managing patients with OTE.

在资源匮乏的环境中,对接受先天性心脏病手术的儿童进行台上拔管对资源利用率和产妇焦虑的影响。
目的研究先天性心脏手术后台上拔管(OTE)方案在低资源环境中的适用性及其对重症监护室(ICU)停留时间、住院时间、住院费用、家长焦虑和护士焦虑的影响:在这项前瞻性、非随机、观察性单中心研究中,我们纳入了所有接受先天性心脏手术的 1 岁以上儿童。在脱离心肺旁路后,我们采用预先规定的方案对他们进行了 OTE 可行性评估。我们对先天性心脏病手术风险调整 1、2、3 和 4 组的 60 名 1 岁以上患儿进行了前瞻性数据收集,并将其分为两组:成功接受 OTE 的患儿和术后任何时间均需通气的患儿(每组 30 名)。收集了住院时间、重症监护室住院时间和住院总费用。在患儿到达重症监护室后,立即使用国家特质焦虑量表(STAI)评估重症监护室主要护理人员(护士)和患儿母亲的焦虑水平:结果:先天性心脏病手术后立即拔管的患儿在重症监护室的住院时间明显更短(中位 20 [19, 22] h vs. 22 [20, 43] h [P < 0.05])。与术后通气的患儿相比,在手术台上拔管的患儿住院费用明显减少{中位数161,000卢比(138,330;211,900),约合1970美元(P<0.05)}{中位数201,422卢比(151,211;211,900),约合2464美元}。孩子在手术室拔管时,母亲的焦虑程度明显降低(STAI 36.5 ± 5.4 vs. 47.4 ± 7.4,P < 0.001)。然而,对于同一组患者,重症监护室护士的焦虑水平明显更高(STAI 46.0 ± 5.6 vs. 37.8 ± 4.1,P < 0.05):结论:先天性心脏病手术后的 OTE 与缩短重症监护室住院时间和住院时间有关。结论:先天性心脏病手术后的 OTE 可缩短重症监护室的住院时间和住院时间,还能降低住院总费用,减轻先天性心脏病手术患儿母亲的焦虑程度。不过,在儿童入住重症监护室期间,主要床边护理人员在管理 OTE 患者时会更加焦虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Pediatric Cardiology
Annals of Pediatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.40
自引率
14.30%
发文量
51
审稿时长
23 weeks
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