Early tracheal extubation in the operating room after atrial septal defect (ASD) surgery was recommended as part of a clinical practice guideline (CPG) established in the Cardiovascular Program at the Children's Hospital, Boston, MA. This retrospective review was undertaken to determine whether this practice was efficient without compromising patient care. The charts and hospital charges for 102 patients undergoing secundum ASD or sinus venosus defect surgery between March 1992 and July 1994 were reviewed; 36 patients (Group I) had surgery prior to introduction of the CPG, and 66 patients were managed according to the CPG. Of the latter, 25 patients (Group II) were tracheally extubated in the operating room (OR) and 41 patients (Group III) were extubated in the cardiac intensive care unit (CICU). Patients in all three groups were similar with respect to height, weight, and surgical conditions including cardiopulmonary bypass time, lowest esophageal temperature, hematocrit, total OR time, and the time from completion of bypass to leaving the OR. Patients in Group II received significantly less fentanyl during anesthesia, were more likely to have a respiratory acidosis on admission to the CICU, and had an increased frequency of vomiting in the CICU. There was no difference in duration of CICU stay among groups. The length of hospital stay was reduced in Groups II and III after introduction of the CPGs, but was not influenced by tracheal extubation in the OR. There was no difference among groups in the hospital charges for OR, anesthesia and CICU time. However, when the combined hospital charges for services provided both in the OR and CICU were included, patients in Group II were charged significantly less, and this primarily reflects the absence of postoperative mechanical ventilation charges. Tracheal extubation in the OR after ASD surgery in children can result in lower patient charges without significantly compromising patient care.

译文

建议将房间隔缺损 (ASD) 手术后在手术室进行早期气管拔管,作为马萨诸塞州波士顿儿童医院心血管计划中建立的临床实践指南 (CPG) 的一部分。进行这项回顾性审查是为了确定这种做法在不影响患者护理的情况下是否有效。回顾了1992年3月至1994年7月之间接受secundum ASD或鼻窦静脉缺损手术的102例患者的图表和住院费用; 36例患者 (I组) 在引入CPG之前进行了手术,66例患者根据CPG进行了治疗。在后者中,25例患者 (II组) 在手术室 (OR) 气管拔管,41例患者 (III组) 在心脏重症监护病房 (CICU) 拔管。三组患者的身高,体重和手术条件相似,包括体外循环时间,最低食管温度,血细胞比容,总或时间以及从旁路完成到离开OR的时间。第二组患者在麻醉期间接受的芬太尼明显减少,入院时更容易出现呼吸性酸中毒,并且在CICU中呕吐的频率增加。各组间CICU停留时间无差异。引入CPGs后,II组和III组的住院时间减少了,但不受OR中气管拔管的影响。两组之间的医院费用,麻醉和CICU时间没有差异。但是,如果将OR和CICU中提供的服务的合并医院费用包括在内,则II组患者的费用明显减少,这主要反映了术后没有机械通气费用。儿童ASD手术中或之后的气管拔管可降低患者费用,而不会显着影响患者的护理。

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