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Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors

A. Marc Harrison1, Amy C. Cox, Steve Davis

  • 1Departments of Pediatric Critical Care Medicine (AMH, SD), General Pediatrics, Biostatistics and Epidemiology, and Cardiology and Congenital Heart Surgery (JJDW, RBBM), Division of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH.

Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
|June 5, 2003
PubMed

Insights

Failed extubation (FE) occurs in about 10% of young children after congenital heart surgery. Key risk factors include pulmonary hypertension, Down syndrome, and deep hypothermic circulatory arrest, aiding in predicting extubation success.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Congenital Heart Surgery

Background:

  • Mechanical ventilation is common post-congenital heart surgery.
  • Failed extubation (FE) can lead to instability and prolonged ventilation.
  • Identifying FE risk factors is crucial for optimizing patient care.

Purpose of the Study:

  • To determine the frequency of FE after congenital heart surgery in young children.
  • To investigate the causes and risk factors associated with FE.
  • To develop a predictive model for FE.

Main Methods:

  • Retrospective chart review of children <=36 months undergoing congenital heart surgery (1998-1999).
  • Defined FE as reintubation within 24 hours.
  • Used modified logistic regression to identify independent risk factors for FE.

Main Results:

  • FE occurred in 25.9% of initial extubation attempts.
  • Common causes of FE included cardiac dysfunction, lung disease, and airway edema.
  • Independent risk factors for FE were pulmonary hypertension, Down syndrome, and deep hypothermic circulatory arrest.

Conclusions:

  • Approximately 10% of young patients experience FE after congenital heart surgery.
  • Pulmonary hypertension is the strongest predictor of FE.
  • Further validation of the predictive model is recommended.

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