A Single-Center Experience of Extubation Failure in Infants Undergoing the Norwood Operation

Risk Factors for Extubation Failure Following Neonatal Cardiac Surgery*

“…In our study, extubation failure occurred in nearly one-fifth of neonates, which is consistent with the range of 10-27% reported in other studies of children recovering from pediatric cardiac surgery [10][11][12][13][14][15]. The definition of extubation failure has varied in prior studies examining extubation failure in children with cardiac disease [10][11][12][13][14][15], with some defining extubation failure as the need for re-intubation within 24-48 hours while others have used 96 hours as their definition. Authors who have employed the latter definition [13][14][15] have asserted that extubation failure in patients with underlying cardiac disease can be slow to evolve and thus the time frame for extubation failure should be expanded beyond 48 hours.…”

“…The definition of extubation failure has varied in prior studies examining extubation failure in children with cardiac disease [10][11][12][13][14][15], with some defining extubation failure as the need for re-intubation within 24-48 hours while others have used 96 hours as their definition. Authors who have employed the latter definition [13][14][15] have asserted that extubation failure in patients with underlying cardiac disease can be slow to evolve and thus the time frame for extubation failure should be expanded beyond 48 hours. We agreed with this latter sentiment though we opted to limit the definition to 72 hours based on anecdotal observations from quality assurance efforts at our institution, in which we have found extubation failure beyond 72 hours to be uncommon.…”

“…Extubation failure is often tumultuous in these patients, and can be associated with considerable postoperative morbidity and prolonged length of stay in the intensive care unit, especially in neonates [10]. To date, existing literature that has reported risk factors for extubation failure specific to patients recovering from pediatric cardiac surgery have been either large heterogeneous groups of children that ranged widely in age [11][12] or smaller studies focused on specific lesions [13][14][15]. We hypothesized that a study focused solely on neonates but inclusive of all neonatal cardiac lesions would not only identify patient characteristics associated with extubation failure but would also identify specific cardiac defects at increased risk for this undesirable outcome.…”

Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

“…Following reintubation, these neonates are then committed to another course of mechanical ventilation, with its inherent risks and exposures such as ventilator-associated infections, airway trauma, and the need for sedative infusions. In neonates and children undergoing cardiac surgery, extubation failure has been consistently associated with increased postoperative morbidity and mortality [3][4][5][6][7]. Prevention of this important complication is therefore an essential part of optimizing clinical outcomes in this patient population.…”

“…In many cases, despite reassuring respiratory and hemodynamic indices, extubation failure still occurs. Initial studies focused on extubation failure after surgery for congenital heart disease in neonates, while providing some valuable insight, have been restricted to small single center cohorts and thus have had limited generalizability [6,7,9] In a recent review of data from the Pediatric Cardiac Critical Care Consortium (PC4), only the presence of an underlying anatomic airway anomaly could be identified as an independent risk factor for extubation failure after neonatal cardiac surgery, but the analysis in this study was limited to the variables available within the registry [10]. We aimed to describe the epidemiology of extubation failure in a large multicenter population of neonates undergoing surgery for congenital heart disease.…”