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A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Risk factors for mechanical ventilation and reintubation after pediatric heart surgery
Punkaj Gupta1, Mallikarjuna Rettiganti2, Jeffrey M Gossett2
1Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Ark.
Insights
Extubation in the operating room after pediatric heart surgery is uncommon but successful for most patients. Factors like complex operations and lower-volume centers increase the need for mechanical ventilation and reintubation.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Cardiovascular Research
Background:
- Mechanical ventilation and reintubation are significant concerns in pediatric cardiac surgery patients.
- Understanding the prevalence and risk factors is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine the prevalence of mechanical ventilation and reintubation in children after cardiac surgery.
- To identify risk factors associated with the need for mechanical ventilation and reintubation.
Main Methods:
- Analysis of a large multicenter database (Virtual PICU Systems) of pediatric patients undergoing cardiac operations (2009-2014).
- Multivariable logistic regression models were used to identify associated factors.
- Propensity-matched analysis compared centers with and without dedicated cardiac ICUs.
Main Results:
- 25% of patients were extubated in the operating room (OR); 75% arrived intubated in the ICU.
- Reintubation rates were 6% for OR-extubated patients versus 10% for ICU-admitted intubated patients.
- Higher complexity operations, lower-volume centers, and patient characteristics were associated with increased need for ventilation/reintubation. Centers with dedicated cardiac ICUs showed lower rates.
Conclusions:
- The proportion of pediatric cardiac surgery patients extubated in the OR is low.
- Extubation in the OR can be performed successfully with a low complication rate.
- Dedicated cardiac ICUs may be associated with better outcomes regarding mechanical ventilation and reintubation.
Objective:
To determine the prevalence of and risk factors associated with the need for mechanical ventilation in children following cardiac surgery and the need for subsequent reintubation after the initial extubation attempt.
Methods:
Patients younger than 18 years who underwent cardiac operations for congenital heart disease at one of the participating pediatric intensive care units (ICUs) in the Virtual PICU Systems (VPS), LLC, database were included (2009-2014). Multivariable logistic regression models were fitted to identify factors likely associated with mechanical ventilation and reintubation.
Results:
A total of 27,398 patients from 62 centers were included. Of these, 6810 patients (25%) were extubated in the operating room (OR), whereas 20,588 patients (75%) arrived intubated in the ICU. Of the patients who were extubated in the OR, 395 patients (6%) required reintubation. In contrast, 2054 patients (10%) required reintubation among the patients arriving intubated postoperatively in the ICU. In adjusted models, patient characteristics, patients undergoing high-complexity operations, and patients undergoing operations in lower-volume centers were associated with higher likelihood for the need for postoperative mechanical ventilation and need for reintubation. Furthermore, the prevalence of mechanical ventilation and reintubation was lower among the centers with a dedicated cardiac ICU in propensity-matched analysis among centers with and without a dedicated cardiac ICU.
Conclusions:
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.
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