背景:外科主动脉瓣置换术(SAVR)是严重钙化性主动脉瓣狭窄的既定治疗方法。心脏手术(ERACS)方案的增强恢复已被证明可以改善选择性心脏手术的结果。COVID-19大流行促使择期手术后早期拔管,以保留重症监护资源。
目的:研究选择SAVR后6h内拔管对住院时间和ICU住院时间的影响,死亡率,ICU再入院,和术后肺炎。
方法:对亚琛大学医院的回顾性分析,德国,包括2017年至2022年的数据,并比较了总共73名选择性SAVR患者。其中,23例患者在6h内拔管(EXT组),而50例患者仍插管超过6小时(INT组)。
结果:INT组术后通气时间较长,需要更多的血管加压药支持,术后肺炎的发生率较高,ICU住院时间更长。总体住院时间没有显着差异,死亡率,或ICU再入院率。
结论:这项研究表明,早期拔管高危人群,多主动脉瓣置换术患者是安全的,并与肺炎发病率的降低有关,ICU和住院时间较短,加强ERACS协议的好处,在COVID-19大流行期间,优化重症监护使用尤其重要。
BACKGROUND: Surgical aortic valve replacement (SAVR) is an established therapy for severe calcific aortic stenosis. Enhanced recovery after cardiac surgery (ERACS) protocols have been shown to improve outcomes for elective cardiac procedures. The COVID-19 pandemic prompted early extubation post-elective surgeries to preserve critical care resources.
OBJECTIVE: To investigate the effects of extubating patients within 6 h post-elective SAVR on hospital and ICU length of stay, mortality rates, ICU readmissions, and postoperative pneumonia.
METHODS: The retrospective analysis at the University Hospital Aachen, Germany, includes data from 2017 to 2022 and compares a total of 73 elective SAVR patients. Among these, 23 patients were extubated within 6 h (EXT group), while 50 patients remained intubated for over 6 h (INT group).
RESULTS: The INT group experienced longer postoperative ventilation, needed more vasopressor support, had a higher incidence of postoperative pneumonia, and longer ICU length of stay. No significant differences were noted in overall hospital length of stay, mortality, or ICU readmission rates between the groups.
CONCLUSIONS: This study demonstrates that early extubation in high-risk, multimorbid surgical aortic valve replacement patients is safe, and is associated with a reduction of pneumonia rates, and with shorter ICU and hospital length of stays, reinforcing the benefits of ERACS protocols, especially critical during the COVID-19 pandemic to optimize intensive care use.