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Updated: Aug 29, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Factors associated with early extubation after cardiac surgery in young children
Steve Davis1, Sarah Worley, Roger B B Mee
1Department of Pediatric Critical Care Medicine, Division of Pediatrics, Children's Hospital at the Cleveland Clinic, Cleveland, OH 44195, USA. Daviss1@ccf.org
Insights
Preoperative factors like older age and absence of pulmonary hypertension significantly predict successful early extubation in children after congenital heart surgery. Identifying these factors can improve patient outcomes and reduce ventilation time.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Cardiovascular Research
Background:
- Mechanical ventilation is essential for children post-congenital heart surgery.
- Predicting successful early extubation (<24 hours) is crucial for optimizing patient recovery and resource allocation.
Purpose of the Study:
- To identify pre- and intraoperative factors associated with successful early extubation in pediatric patients undergoing congenital heart surgery.
- To develop a predictive model for early extubation success.
Main Methods:
- Retrospective chart review of 203 children (<36 months) undergoing congenital heart surgery between January 1998 and July 1999.
- Generalized Estimating Equation models were used to assess associations between pre- and intraoperative factors and early extubation.
- Multivariable models were adjusted for procedure group, with forward selection and AUC calculation.
Main Results:
- 47% of children were extubated within 24 hours, with a low failure rate (1%).
- Key preoperative factors for early extubation included age >6 months, absence of pulmonary hypertension, gestational age >36 weeks, and absence of congestive heart failure.
- A model incorporating multiple preoperative factors showed significantly increased odds of successful extubation with more contributing factors (EOR 4.2 to 76.5).
Conclusions:
- Early extubation is feasible and safe in a significant proportion of young children after congenital heart surgery.
- Preoperative factors are stronger predictors of early extubation success than intraoperative variables.
- Prospective validation with larger, multi-institutional cohorts is recommended to refine the predictive model.
Objective:
Children undergoing congenital heart surgery require mechanical ventilation. We sought to identify pre- and intraoperative factors (PrO, IO) associated with successful early extubation <24 hrs.
Design And Patients:
We performed a retrospective chart review of children <36 months old who underwent congenital heart surgery from January 1998 to July 1999.
Setting:
Pediatric intensive care unit in a children's hospital.
Measurements:
Generalized Estimating Equation models were fit to assess the association between PrO and IO and early extubation while accounting for the correlation between surgeries performed on the same patient. Estimated odds ratios (EOR) and 95% confidence intervals were calculated. Multivariable models were constructed using a forward selection process with inclusion criteria of p<.05. Multivariable models, which included PrO and IO variables, were adjusted for procedure group. The area under the receiver operating characteristic curve was computed for each model.
Results:
A total of 203 children underwent 219 surgeries; 103 (47%) children were extubated in <24 hrs, with only one (1%) failed extubation. PrO variables associated with successful early extubation included age >6 months (EOR, 6.1), absence of pulmonary hypertension (EOR, 9.1), gestational age >36 wks (EOR, 4.6), and absence of congestive heart failure (EOR, 2.4). IO variables were less likely to be associated with successful early extubation. Our model of PrO variables with multiple factors showed that presence of two factors was associated with an EOR of 4.2 for successful early extubation compared with children with zero or one factor. Presence of three and four factors was associated with an EOR of 18.0 and 76.5, respectively. The area under the receiver operating characteristic curve for this model is 0.816. Incision type, complex vs. simple procedure, and palliative vs. complete repair were not associated with success of early extubation.
Conclusions:
Early extubation is possible in many very young children undergoing congenital heart surgery, with a low rate of failed extubation. The model would be improved by prospective validation with larger numbers at multiple institutions.
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