Preditores de falha da extubação em neonatos após cirurgia cardíaca: revisão sistemática
DOI:
https://doi.org/10.34119/bjhrv8n6-317Keywords:
extubação, cardiopatias, recém-nascidosAbstract
Um maior conhecimento acerca da fisiologia e anatomia das diferentes cardiopatias congênitas nos últimos 60 anos aperfeiçoou o diagnóstico e o tratamento dessas doenças. Apesar dos avanços da medicina, que aceleraram o processo de desmame ventilatório na população pediátrica no pós-operatório de cirurgia cardíaca, os neonatos ainda permanecem períodos prolongados em ventilação mecânica invasiva. Apesar de necessária, a ventilação mecânica está relacionada com o aparecimento de complicações pulmonares, trauma das vias aéreas e necessidade de drogas sedativas, fatores que influenciam negativamente o prognóstico desses pacientes. O objetivo deste estudo foi realizar uma revisão sistemática acerca dos preditores da falha de extubação em neonatos após cirurgia cardíaca. Foi realizada uma busca nas bases de dados eletrônicos Medline (via Pubmed), EMBASE, Cochrane CENTRAL, Lilacs e PEDro, além de busca manual nas referências de estudos já publicados. O período da busca foi desde o início das bases até abril de 2018, utilizando os seguintes descritores em inglês: “Cardiac Surgery" e “Extubation Failure” associados a seus termos sinônimos e a uma lista de termos sensíveis. Foram incluídos cinco estudos que encontraram anomalias nas vias aéreas, anormalidades genéticas, hipoplasia do ventrículo esquerdo, infecção pós-operatória, uso do balonete desinsuflado, esterno aberto por mais de quatro dias, tempo prolongado de ventilação mecânica invasiva, uso de óxido nítrico, escore de inotrópicos na saída da sala de operação e presença de atelectasia antes da extubação como preditores independentes da falha da extubação em neonatos após cirurgia cardíaca.
References
Van Der Linde D, Konings EEM, Slager MA, Witsenburg M, Helbing WA, Takkenberg JJM, et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. J Am Coll Cardiol. 2011;58(21):2241–7.
Tchervenkov CI, Jacobs JP, Bernier P-L, Stellin G, Kurosawa H, Mavroudis C, et al. The improvement of care for paediatric and congenital cardiac disease across the World: a challenge for the World Society for Pediatric and Congenital Heart Surgery. Cardiol Young [Internet]. 2008;18(S2):63. Available from: http://www.journals.cambridge.org/abstract_S1047951108002801
Hamilton BCS, Honjo O, Alghamdi AA, Caldarone CA, Schwartz SM, Van Arsdell GS, et al. Efficacy of Evolving Early-Extubation Strategy on Early Postoperative Functional Recovery in Pediatric Open-Heart Surgery. Semin Cardiothorac Vasc Anesth [Internet]. 2014;18(3):290–6. Available from: http://journals.sagepub.com/doi/10.1177/1089253213519291
Mutsuga M, Quiñonez LG, MacKie AS, Norris CM, Marchak BE, Rutledge JM, et al. Fast-track extubation after modified Fontan procedure. J Thorac Cardiovasc Surg. 2012;144(3):547–52.
I. P-K, M. P-P, W. K, J.J. M. Predictors of long intensive care unit stay following cardiac surgery in children. Eur J Cardio-thoracic Surg [Internet]. 2011;40(1):179–84. Available from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed10&NEWS=N&AN=2011307840
Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med. 2011;12(3):e122–6.
Miller JD, Carlo WA. Pulmonary Complications of Mechanical Ventilation in Neonates. Vol. 35, Clinics in Perinatology. 2008. p. 273–81.
Alghamdi AA, Singh SK, Hamilton BCS, Yadava M, Holtby H, Van Arsdell GS, et al. Early Extubation after Pediatric Cardiac Surgery: Systematic Review, Meta-analysis, and Evidence-Based Recommendations. J Card Surg [Internet]. 2010;25(5):586–95. Available from: http://doi.wiley.com/10.1111/j.1540-8191.2010.01088.x
Baisch SD, Wheeler WB, Kurachek SC, Cornfield DN. Extubation failure in pediatric intensive care incidence and outcomes. Pediatr Crit Care Med [Internet]. 2005;6(3):312–8. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00130478-200505000-00014
Gaies M, Tabbutt S, Schwartz SM, Bird GL, Alten JA, Shekerdemian LS, et al. Clinical Epidemiology of Extubation Failure in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium. Pediatr Crit Care Med. 2015;16(9):837–45.
Mastropietro CW, Cashen K, Grimaldi LM, Narayana Gowda KM, Piggott KD, Wilhelm M, et al. Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis. J Pediatr. 2017;182:190–196.e4.
Laudato N, Gupta P, Walters HL, Delius RE, Mastropietro CW. Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery. Pediatr Crit Care Med [Internet]. 2015;16(9):859–67. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00130478-201511000-00009
Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hosp Res Inst [Internet]. 2013;(3):1–4. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm
Gupta P, McDonald R, Gossett JM, Butt W, Shinkawa T, Imamura M, et al. A single-center experience of extubation failure in infants undergoing the norwood operation. Ann Thorac Surg. 2012;94(4):1262–8.
Benneyworth BD, Mastropietro CW, Graham EM, Klugman D, Costello JM, Zhang W, et al. Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals. J Thorac Cardiovasc Surg. 2017;153(6):1519–26.
Miura S, Hamamoto N, Osaki M, Nakano S, Miyakoshi C. Extubation Failure in Neonates After Cardiac Surgery: Prevalence, Etiology, and Risk Factors. Ann Thorac Surg. 2017;103(4):1293–8.
Huang RY, Shapiro NL. Structural airway anomalies in patients with DiGeorge syndrome: A current review. Am J Otolaryngol - Head Neck Med Surg. 2000;21(5):326–30.
Hickey EJ, Caldarone CA, McCrindle BW. Left ventricular hypoplasia: A spectrum of disease involving the left ventricular outflow tract, aortic valve, and aorta. J Am Coll Cardiol. 2012;59(1 SUPPL.).
Gaies MG, Gurney JG, Yen AH, Napoli ML, Gajarski RJ, Ohye RG, et al. Vasoactive–inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med [Internet]. 2010;11(2):234–8. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00130478-201003000-00009
Davidson J, Tong S, Hancock H, Hauck A, Da Cruz E, Kaufman J. Prospective validation of the vasoactive-inotropic score and correlation to short-term outcomes in neonates and infants after cardiothoracic surgery. Intensive Care Med. 2012;38(7):1184–90.
Veyckemans F. New developments in the management of the paediatric airway: Cuffed or uncuffed tracheal tubes, laryngeal mask airway, cuffed oropharyngeal airway, tracheostomy and one-lung ventilation devices. Vol. 12, Current Opinion in Anaesthesiology. 1999. p. 315–20.
Flynn PE, Black AE, Mitchell V. The use of cuffed tracheal tubes for paediatric tracheal intubation, a survey of specialist practice in the United Kingdom. Eur J Anaesthesiol. 2008;25(8):685–8.
Weiss M, Dullenkopf A, Gysin C, Dillier CM, Gerber AC. Shortcomings of cuffed paediatric tracheal tubes. Br J Anaesth. 2004;92(1):78–88.
Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 2016;30(1):3–11.
Hurtado-Sierra D, Calderón-Colmenero J, Curi-Curi P, Cervantes-Salazar J, Sandoval JP, García-Montes JA, et al. Outcomes of Delayed Sternal Closure in Pediatric Heart Surgery: Single-Center Experience. Biomed Res Int. 2018;2018.
Lindberg L, Olsson AK, Jögi P, Jonmarker C. How common is severe pulmonary hypertension after pediatric cardiac surgery? J Thorac Cardiovasc Surg. 2002;123(6):1155–63.
Miller O, Tang SF, Keech A, Pigott NB, Beller E, Celermajer DS. Inhaled nitric oxide and prevention of pulmonary hypertension after congenital heart surgery: A randomised double-blind study. Lancet. 2000;356(9240):1464–9.
Albu G, Babik B, Késmárky K, Balázs M, Hantos Z, Peták F. Changes in Airway and Respiratory Tissue Mechanics After Cardiac Surgery. Ann Thorac Surg. 2010;89(4):1218–26.
Cantinotti M, Giordano R, Corana G, Franchi E, Koestenberger M, Kutty S. Use of linear and convex ultrasound transducers for evaluation of retrosternal area in patients after cardiac surgery. Echocardiography. 2018;35(1):100–3.
Ovroutski S, Alexi-Meskishvili V, Stiller B, Ewert P, Abdul-Khaliq H, Lemmer J, et al. Paralysis of the phrenic nerve as a risk factor for suboptimal Fontan hemodynamics. Eur J Cardio-thoracic Surg. 2005;27(4):561–5.
Scodellaro T, McKenzie JM, D’Udekem Y, Butt W, Namachivayam SP. Extubation Failure Is Associated with Increased Mortality Following First Stage Single Ventricle Reconstruction Operation. Pediatr Crit Care Med. 2017;18(12):1136–44.
Newth CJL, Venkataraman S, Willson DF, Meert KL, Harrison R, Dean JM, et al. Weaning and extubation readiness in pediatric patients. Vol. 10, Pediatric Critical Care Medicine. 2009. p. 1–11.
