Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis

Abstract

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.

Multicenter Validation of the Vasoactive-Ventilation-Renal Score as a Predictor of Prolonged Mechanical Ventilation After Neonatal Cardiac Surgery*

“…The study was a retrospective multicenter cohort study. We collected additional data on neonates who had previously been prospectively enrolled in an observational study examining extubation failure after neonatal cardiac surgery from January 1, 2015 through December 31, 2015 (11…”

“…For this study, we sought to perform the first multicenter validation of the VVR score utilizing a dataset containing neonates who underwent cardiac surgery at seven tertiary care centers within the United States (11). We hypothesized that the VVR would be a reliable predictor of outcome in this patient population and continue to outperform more traditional measures of disease complexity and severity.…”

Near-infrared spectroscopy for prediction of extubation success after neonatal cardiac surgery

“…Previous studies have suggested that extubation failure in children with cardiac disease is a poor prognostic sign associated with a higher mortality. 2,3 Neonates in particular have a higher rate of extubation failure (12 %) as compared to older children. [3][4][5] Reported rates of extubation failure after neonatal cardiac surgery range from 5 to 23 %.…”

“…2,3 Neonates in particular have a higher rate of extubation failure (12 %) as compared to older children. [3][4][5] Reported rates of extubation failure after neonatal cardiac surgery range from 5 to 23 %. 3,5,6 Common indicators utilised for assessing extubation readiness following congenital heart surgery include subjective and objective measures of neuromuscular function and oxygenation and ventilation and indirect markers of adequate cardiac output.…”

“…[3][4][5] Reported rates of extubation failure after neonatal cardiac surgery range from 5 to 23 %. 3,5,6 Common indicators utilised for assessing extubation readiness following congenital heart surgery include subjective and objective measures of neuromuscular function and oxygenation and ventilation and indirect markers of adequate cardiac output. 4 However, extubation readiness tools that have incorporated these indicators have not yet been proven to be reliable in neonates.…”