To Determine the Incidence and Risk Factors for Prolonged Intensive Care Unit Stay in Children with Congenital Heart Diseases Undergoing Open Heart Surgeries

Abstract

Objectives: This study aimed to assess the risk factors for prolonged intensive care unit stay postoperatively in patients with congenital heart disease.

Study Design: Observational study

Study Setting and Duration: The study was undertaken at the Intensive Care Unit, Pediatric Cardiac Department at the National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan from August 2021 to February 2022.

Methods: All children under the age of 18 years who were admitted to our center for the management of congenital heart diseases such as atrial or ventricular septal defects were eligible to partake in the study. The data related to determinants of prolonged intensive care length of stay in 100 children after cardiac surgery was recorded in a predefined proforma. Complications postoperatively were also reported. All data were analyzed using the statistical package for social sciences (SPSS) version 26.

Results: Longer duration of bypass (p=0.001), higher postoperative lactate levels (p<0.0001), decreased postoperative tricuspid annular plane systolic excursion (TAPSE) (p<0.0001), reduced postoperative left ventricular ejection fraction (LVEF) (p=0.006), Postoperative Arterio-venous differences of oxygen (AVDO2) (p<0.0001), and acidosis (p=0.009) were all significantly correlated with prolonged ICU stay. ICU length of stay correlated significantly with certain complications including low cardiac output (p=0.0003), arrhythmias (p=0.0005), and right ventricle dysfunction (p=0.0006).

Conclusion: The present study identifies various patient outcomes and complications including postoperative low cardiac output, arrhythmias, and right ventricular dysfunction, and reduced left ventricular ejection fraction that were significantly correlated with prolonged ICU stay.