Corticosteroids and Outcome in Children Undergoing Congenital Heart Surgery

Objectives: To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease. Study Design:We conducted a prospective observational study of neonates ≤ 30 days of age who underwent cardiac surgery at seven centers within the United States in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified using multivariable logistic regression analysis and reported as odds ratios (OR) with 95% confidence intervals (CI). Multivariable logistic regression analysis was also conducted to examine the relationship between extubation failure and worse clinical outcome, defined as hospital length-of-stay in the upper 25% or operative mortality.

show abstract

“…systemic inflammatory response syndrome with suspected infection) treated with ≥ 7 days of antimicrobial therapy [13] • Necrotizing enterocolitis…”

Section: Preoperative Datamentioning

confidence: 99%

Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

Mastropietro

Cashen

Grimaldi

et al. 2017

The Journal of Pediatrics

View full text Add to dashboard Cite

show abstract

“…We cannot discount the possibility that we would have found a higher rate of upper airway obstruction had this practice been less readily employed. In light of our current findings, the conflicting nature of the data on dexamethasone use to prevent re-intubation in neonates and children, 19 and more recent data linking perioperative and postoperative corticosteroid use in pediatric cardiac surgical patients to postoperative infection, [20][21] further studies are needed before this practice can be readily promoted.…”

Section: Discussionmentioning

confidence: 87%

Prevalence and Risk Factors for Upper Airway Obstruction after Pediatric Cardiac Surgery

Green

Walters

Delius

et al. 2015

The Journal of Pediatrics

View full text Add to dashboard Cite

Objective: To determine the incidence of and risk factors for extrathoracic upper airway obstruction after pediatric cardiac surgery.Study Design: A retrospective chart review was performed on 213 patients less than 18 years of age who recovered from cardiac surgery in our multidisciplinary intensive care unit in 2012.Clinically significant upper airway obstruction was defined before performing the chart review as post-extubation stridor with at least one of the following: greater than two corticosteroid doses, receiving helium-oxygen therapy, or re-intubation. Multivariate logistic regression analysis was performed to determine independent risk factors for this complication.Results: Thirty-five patients (16%) with extrathoracic upper airway obstruction were identified.On bivariate analysis, patients with upper airway obstruction had greater surgical complexity, higher vasoactive medication requirements, and longer postoperative durations of endotracheal intubation. They were also more difficult to calm while on mechanical ventilation, as indicated by higher narcotic infusion doses and greater likelihood to receive dexmedetomidine or vecuronium. On multivariable analysis, adjunctive use of dexmedetomedine or vecuronium (odds ratio: 4.4, 95% confidence intervals: 1.8-10.5) remained independently associated with upper airway obstruction. Conclusion:Extrathoracic upper airway obstruction is relatively common following pediatric cardiac surgery, especially in children who are difficult to calm while endotracheally intubated.Postoperative upper airway obstruction could represent an important outcome measure in future studies of optimal sedation practices in this patient population.2

show abstract

“…La necesidad de cierre esternal diferido fue mayor en estos pacientes y con una estadía más prolongada en la unidad de paciente crítico. Los factores de riesgo estudiados concuerdan con los descritos en otros estudios [16][17][18][19][20][21][22][23][24] . Levy y cols.…”

Section: Discussionunclassified