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Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease
José A García-Montes1, Juan Calderón-Colmenero, Miguel Casanova
1Departamento de Cardiología Pediátrica, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, México, DF. pepegamon@yahoo.com
Insights
Infants under one year old, pulmonary hypertension, and cardiac failure are key factors leading to prolonged mechanical ventilation (MV) after pediatric heart surgery. These conditions significantly increase the risk and duration of MV support in critically ill children.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Thoracic Surgery
Background:
- Congenital heart defects necessitate surgical intervention in pediatric patients.
- Mechanical ventilation (MV) is a critical support measure post-cardiac surgery.
- Identifying factors for prolonged MV is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify predictors of prolonged mechanical ventilation (MV) in children undergoing surgery for congenital heart defects.
- To analyze the association between patient demographics, clinical conditions, and MV duration.
Main Methods:
- Prospective cohort study conducted in a pediatric critical care unit.
- Enrolled 318 children (<18 years) undergoing cardiovascular surgery for congenital heart defects.
- Assessed factors contributing to prolonged MV (>120 hours).
Main Results:
- Prolonged MV was required in 2.8% of patients.
- Risk factors for prolonged MV included age < 1 year, pulmonary hypertension, and cardiac failure.
- Patients with cardiac failure or pulmonary hypertension experienced significantly longer MV durations.
- Extubation failure occurred in 8.5% of patients, often due to hemodynamic instability.
- Mortality rate was 34% for patients requiring prolonged MV.
Conclusions:
- Pediatric patients younger than one year, those with pulmonary hypertension, and those experiencing cardiac failure are at higher risk for prolonged mechanical ventilation.
- These factors are significant predictors of extended respiratory support needs post-cardiac surgery.
- Early identification and management of these risk factors can potentially improve outcomes for children with congenital heart defects.
Objective:
The purpose of this study was to determine factors contributing to prolonged mechanical ventilation in children following surgery for congenital heart defects.
Design:
Prospective cohort trial.
Setting:
Critical Care Unit. "Ignacio Chávez" National Heart Institute, México; from January to December 2000.
Patients:
A total of 318 consecutive patients < 18 years old who underwent cardiovascular surgical procedures for congenital heart defects were enrolled in this study. Of these, 297 patients were admitted to the intensive care unit with respiratory support and 2.8% required prolonged mechanical ventilation (MV) > 120 hours.
Measurements And Main Results:
Patients with cardiac failure had MV time of 214 +/- 200 hours, whereas those without it had MV time of 33 +/- 73 hours (p > 0.001). Patients with severe pulmonary hypertension had MV time of 160 +/- 176 hours, while those who did not had MV time of 47 +/- 105 hours (p < 0.001). Twenty-four patients (8.5%) had extubation failure, in 79% them due to hemodynamic alteration during the respiratory support time of 277 +/- 188 hours versus the rest of the group with MV time of 41 +/- 92 hours (p < 0.001). Factors associated with prolonged MV (> 120 hours) were: patients ages of < 1 year, pulmonary hypertension, and cardiac failure, and represented the greatest risk (90%, CI 58 to 99) of prolonging MV. Mortality rate was 34% for patients with prolonged MV. Times of aortic clamping and cardiopulmonary bypass were not significant risk factors for prolonged respiratory support.
Conclusion:
Patients ages of < 1 year old, pulmonary hypertension, and cardiac failure were significant risk factors for prolonged respiratory support.
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