Risk factors for mechanical ventilation and reintubation after pediatric heart surgery

Gupta, Punkaj; Rettiganti, Mallikarjuna; Gossett, Jeffrey M.; Yeh, Justin; Jeffries, Howard E.; Rice, Tom; Wetzel, Randall C.

doi:10.1016/j.jtcvs.2015.09.080

Cited by 62 publications

(68 citation statements)

References 20 publications

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“…The little contribution of the thoracic cage to respiratory function, the relatively weak intercostal muscles, and narrower airway in these age groups were shown to be the anatomical and physiologic reasons for the risk of prolonged MV [7]. Lower body weight and failure to thrive were also risk factors for prolonged MV possibly associated with the same reasons above-mentioned [6,19,20]. Similar to previous reports, younger patient age and lower body weight were associated with prolonged MV in our study.…”

Section: Discussionsupporting

confidence: 88%

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

et al. 2016

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This prospective, observational, single-center study aimed to determine the perioperative predictors of early extubation (<24 h after cardiac surgery) in a cohort of children undergoing cardiac surgery. Children aged between 1 month and 18 years who were consecutively admitted to pediatric intensive care unit after cardiac surgery for congenital heart disease between January 2012 and June 2014. Ninety-nine patients were qualified for inclusion during the study period. The median duration of mechanical ventilation was 20 h (range 1-480), and 64 patients were extubated within 24 h. Four of them failed the initial attempt at extubation, and the success rate of early extubation was 60.6 %. Older patient age (p = .009), greater body weight (p = .009), absence of preoperative pulmonary hypertension (p = .044), lower RACHS-1 category (OR, 3.8; 95 % CI 1.35-10.7; p < .05), shorter cardiopulmonary bypass (p = .008) and cross-clamp (p = .022) times, lower PRISM III-24 (p < .05) and PELOD (p < .05) scores, lower inotropic score (p < .05) and vasoactive-inotropic score (p < .05), and lower number of organ failures (OR, 2.26; 95 % CI 1.30-3.92; p < .05) were associated with early extubation. Our study establishes that early extubation can be accomplished within the first 24 h after surgery in low- to medium-risk pediatric cardiac surgery patients, especially in older ones undergoing low-complexity procedures. A large prospective multiple institution trial is necessary to identify the predictors and benefits of early extubation and to facilitate defined guidelines for early extubation.

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Section: Discussionsupporting

confidence: 88%

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

et al. 2016

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“…We further assessed rates of in-hospital mortality, cardiac ICU duration, and hospital length of stay (LOS) in patients with and without extubation failure to contextualize our results with previous literature. 4,5,7,8 …”

Section: Methodsmentioning

confidence: 99%

“…Among pediatric patients of all ages in the cardiac ICU included in 2 multi-institutional registries, risk factors for extubation failure have included young age, genetic syndromes, surgical complexity, delayed sternal closure, postoperative infections or complications, and duration of mechanical ventilation. 4,5 Neonates in the cardiac ICU consistently have demonstrated an increased risk of extubation failure relative to their pediatric counterparts; previous investigation focusing on these patients consistently report extubation failure rates from 17.5% to 22.0% of patients compared with overall rates of approximately 6% in all patients in the cardiac ICU. 4,7,8 These studies also suggest worse clinical outcomes associated with extubation failure in neonates.…”

mentioning

confidence: 99%

“…1–3 Although early extubation protocols may improve outcomes for certain populations in pediatric cardiac intensive care units (ICUs), extubation failures have been associated with adverse outcomes, including increased duration of hospital stay, cardiac arrest, and mortality. 4,5 Although these outcomes in part reflect overall illness severity and are not exclusively the result of extubation failure, patients may experience downstream complications of extubation failure, such as airway injury, prolonged mechanical ventilation, and the numerous consequences of prolonged exposure to critical care therapies. As such, collaborative efforts to reduce extubation failure events comprising all members of a congenital cardiac surgical program, including surgeons, anesthesiologists, intensivists, and cardiologists, can lead to great benefits for patients.…”

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confidence: 99%

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Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals

Benneyworth

Mastropietro

Graham

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

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Objective In a multicenter cohort of neonates recovering from cardiac surgery, we sought to describe the epidemiology of extubation failure and its variability across centers, identify risk factors, and determine its impact on outcomes. Methods We analyzed prospectively collected clinical registry data on all neonates undergoing cardiac surgery in the Pediatric Cardiac Critical Care Consortium database from October 2013 to July 2015. Extubation failure was defined as reintubation less than 72 hours after the first planned extubation. Risk factors were identified using multivariable logistic regression with generalized estimating equations to account for within-center correlation. Results The cohort included 899 neonates from 14 Pediatric Cardiac Critical Care Consortium centers; 14% were premature, 20% had genetic abnormalities, 18%had major extracardiac anomalies, and 74%underwent surgery with cardiopulmonary bypass. Extubation failure occurred in 103 neonates (11%), within 24 hours in 61%. Unadjusted rates of extubation failure ranged from 5% to 22% across centers; this variability was unchanged after adjusting for procedural complexity and airway anomaly. After multivariable analysis, only airway anomaly was identified as an independent risk factor for extubation failure (odds ratio, 3.1; 95%confidence interval, 1.4–6.7; P = .01). Neonates who failed extubation had a greater median postoperative length of stay (33 vs 23 days, P < .001) and in-hospital mortality (8% vs 2%, P = .002). Conclusions This multicenter study showed that 11% of neonates recovering from cardiac surgery fail initial postoperative extubation. Only congenital airway anomaly was independently associated with extubation failure. We observed a 4-fold variation in extubation failure rates across hospitals, suggesting a role for collaborative quality improvement to optimize outcomes.

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“…Extubation failures have been associated with adverse outcomes, including increased duration of hospital stay, cardiac arrest and mortality (7,8). Some authors (9, 10) used a differIran J Pediatr.…”

Section: Discussionmentioning

confidence: 99%

The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

et al. 2017

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Background: Postoperative mechanical ventilation is required in patients undergoing congenital heart surgery. However, the duration of mechanical ventilation may be extended as a result in some patients. Inflammation is a normal and expected process following surgery and the intensive care process. However, increased and prolonged inflammation increases the risk of mortality and morbidity. The neutrophil lymphocyte ratio (NLR) can be used as a new marker of inflammation in cardiovascular diseases. The aim of our study was to evaluate the association between NLR and successful extubation in pediatric patients undergoing cardiovascular surgery with prolonged intubation.

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Risk factors for mechanical ventilation and reintubation after pediatric heart surgery

Abstract: This multicenter study suggests that proportion of patients extubated in the OR after heart operation is low. These data further suggest that extubation in the OR can be done successfully with a low complication rate.

Cited by 62 publications

References 20 publications

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Predictors of Early Extubation After Pediatric Cardiac Surgery: A Single-Center Prospective Observational Study

Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals

The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

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