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Association between preoperative respiratory support and outcomes in paediatric cardiac surgery.

Publication ,  Journal Article
Ciociola, EC; Kumar, KR; Zimmerman, KO; Thompson, EJ; Harward, M; Sullivan, LN; Turek, JW; Hornik, CP
Published in: Cardiol Young
January 2020

BACKGROUND: Preoperative mechanical ventilation is associated with morbidity and mortality following CHD surgery, but prior studies lack a comprehensive analysis of how preoperative respiratory support mode and timing affects outcomes. METHODS: We retrospectively collected data on children <18 years of age undergoing cardiac surgery at an academic tertiary care medical centre. Using multivariable regression, we examined the association between modes of preoperative respiratory support (nasal cannula, high-flow nasal cannula/noninvasive ventilation, or invasive mechanical ventilation), escalation of preoperative respiratory support, and invasive mechanical ventilation on the day of surgery for three outcomes: operative mortality, postoperative length of stay, and postoperative complications. We repeated our analysis in a subcohort of neonates. RESULTS: A total of 701 children underwent 800 surgical procedures, and 40% received preoperative respiratory support. Among neonates, 243 patients underwent 253 surgical procedures, and 79% received preoperative respiratory support. In multivariable analysis, all modes of preoperative respiratory support, escalation in preoperative respiratory support, and invasive mechanical ventilation on the day of surgery were associated with increased odds of prolonged length of stay in children and neonates. Children (odds ratio = 3.69, 95% CI 1.2-11.4) and neonates (odds ratio = 8.97, 95% CI 1.31-61.14) on high-flow nasal cannula/noninvasive ventilation had increased odds of operative mortality compared to those on room air. CONCLUSION: Preoperative respiratory support is associated with prolonged length of stay and mortality following CHD surgery. Knowing how preoperative respiratory support affects outcomes may help guide surgical timing, inform prognostic conversations, and improve risk stratification models.

Duke Scholars

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Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

January 2020

Volume

30

Issue

1

Start / End Page

66 / 73

Location

England

Related Subject Headings

  • Time Factors
  • Tertiary Care Centers
  • Risk Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Preoperative Care
  • Postoperative Complications
  • North Carolina
  • Noninvasive Ventilation
  • Multivariate Analysis
 

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Ciociola, E. C., Kumar, K. R., Zimmerman, K. O., Thompson, E. J., Harward, M., Sullivan, L. N., … Hornik, C. P. (2020). Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young, 30(1), 66–73. https://doi.org/10.1017/S1047951119002786
Ciociola, Elizabeth C., Karan R. Kumar, Kanecia O. Zimmerman, Elizabeth J. Thompson, Melissa Harward, Laura N. Sullivan, Joseph W. Turek, and Christoph P. Hornik. “Association between preoperative respiratory support and outcomes in paediatric cardiac surgery.Cardiol Young 30, no. 1 (January 2020): 66–73. https://doi.org/10.1017/S1047951119002786.
Ciociola EC, Kumar KR, Zimmerman KO, Thompson EJ, Harward M, Sullivan LN, et al. Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young. 2020 Jan;30(1):66–73.
Ciociola, Elizabeth C., et al. “Association between preoperative respiratory support and outcomes in paediatric cardiac surgery.Cardiol Young, vol. 30, no. 1, Jan. 2020, pp. 66–73. Pubmed, doi:10.1017/S1047951119002786.
Ciociola EC, Kumar KR, Zimmerman KO, Thompson EJ, Harward M, Sullivan LN, Turek JW, Hornik CP. Association between preoperative respiratory support and outcomes in paediatric cardiac surgery. Cardiol Young. 2020 Jan;30(1):66–73.
Journal cover image

Published In

Cardiol Young

DOI

EISSN

1467-1107

Publication Date

January 2020

Volume

30

Issue

1

Start / End Page

66 / 73

Location

England

Related Subject Headings

  • Time Factors
  • Tertiary Care Centers
  • Risk Factors
  • Retrospective Studies
  • Respiration, Artificial
  • Preoperative Care
  • Postoperative Complications
  • North Carolina
  • Noninvasive Ventilation
  • Multivariate Analysis