Date of this Version

2021

Document Type

DNP Project

Abstract

Background: Congenital heart surgery for the pediatric patient has evolved tremendously in the last several decades. The development of new surgical techniques for repair and palliation has revolutionized the long-term outcomes in this patient population. Anesthetic management of the patient undergoing congenital defect surgery has followed similar trends in transforming and improving the patient's perioperative experience. Fast track extubation is practiced in pediatric centers worldwide and has become a vital component in optimizing perioperative management.

Aims: This systematic review aims to determine if fast-track extubation compared to standard extubation will improve patient outcomes such as reduced hospital and intensive care unit length of stay, rate of reintubation, and mortality.

Methodology: A total of six studies were assessed and included in the systematic review. Fast track extubation (in the operating room or less than six hours after surgery) was associated with reduced ICU and hospital length of stays. There was no difference in the rate of reintubation and mortality in those pediatric patients who were extubated early. With this information, a pre-test, educational module, and post-test were created for anesthesia providers to evaluate both baseline knowledge and knowledge growth

Results: The statistical analysis between the pre-test and post-test showed an increase in provider knowledge. There was also an increase in the providers' likelihood to use or recommend fast track extubation techniques.

Conclusion: Fast track extubation appears to be safe and has demonstratable improvements in patient perioperative outcomes. There remains a need for homogeneous, large multicenter randomized control trials to determine a causal effect and demonstrate the potentially significant benefits of fast-track extubation.

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