Related Experiment Video
Updated: Mar 19, 2026
Author Spotlight: Advancing Awake Nasotracheal Intubation with Flexible Video Rhino-Laryngoscopes
Published on: August 2, 2024
Preoperative and Intraoperative Predictive Factors of Immediate Extubation After Neonatal Cardiac Surgery
Joby Varghese1, Shelby Kutty2, Ibrahim Abdullah3
1Department of Anesthesiology, University of Nebraska College of Medicine and Children's Hospital & Medical Center, Omaha, Nebraska.
Insights
Immediate extubation in neonates after open heart surgery reduces intensive care unit (ICU) stay and costs. Key predictors include no need for preoperative ventilation and shorter bypass times, with no increased reintubation risk.
Area of Science:
- Pediatric Cardiac Surgery
- Neonatal Intensive Care
- Anesthesiology
Background:
- Identifying predictors for immediate extubation (IE) in neonates undergoing open heart surgery is crucial.
- Assessing the impact of IE on postoperative outcomes like ICU length of stay (LOS) and costs is essential.
Purpose of the Study:
- To identify preoperative and intraoperative predictors of immediate extubation (IE) in neonates after open heart surgery.
- To evaluate the effect of IE on postoperative ICU LOS, costs, operating room turnover, and reintubation rates.
Main Methods:
- Retrospective study of neonates (<31 days) undergoing cardiac surgery with cardiopulmonary bypass (2010-2013).
- Immediate extubation defined as extubation before anesthetic termination.
- Statistical analyses including propensity scores were used to identify predictors and assess outcomes of IE.
Main Results:
- 30.4% of neonates achieved immediate extubation (IE).
- Predictors of IE included no preoperative ventilation, higher gestational age, anesthesiologist, and shorter cardiopulmonary bypass time.
- IE was associated with shorter ICU LOS (8.3 vs. 12.7 days) and lower ICU costs ($157,449 vs. $198,197), with no significant difference in reintubation rates.
Conclusions:
- Immediate extubation (IE) is feasible in 30.4% of neonates undergoing open heart surgery.
- IE significantly reduces ICU LOS and costs without increasing reintubation rates.
- Factors like low gestational age and need for preoperative ventilation are inversely associated with achieving IE.
Background:
We sought to identify preoperative and intraoperative predictors of immediate extubation (IE) after open heart surgery in neonates. The effect of IE on the postoperative intensive care unit (ICU) length of stay (LOS), cost of postoperative ICU care, operating room turnover, and reintubation rates was assessed.
Methods:
Patients younger than 31 days who underwent cardiac surgery with cardiopulmonary bypass (January 2010 to December 2013) at a tertiary-care children's hospital were studied. Immediate extubation was defined as successful extubation before termination of anesthetic care. Data on preoperative and intraoperative variables were compared using descriptive, bivariate, and multivariate statistics to identify the predictors of IE. Propensity scores were used to assess effects of IE on ICU LOS, the cost of ICU care, reintubation rates, and operating room turnover time.
Results:
One hundred forty-eight procedures done at a median age of 7 days resulted in 45 IEs (30.4%). The IE rate was 22.2% with single-ventricle heart disease. Independent predictors of IE were the absence of the need for preoperative ventilatory assistance, higher gestational age, anesthesiologist, and shorter cardiopulmonary bypass. Immediate extubation was associated with shorter ICU LOS (8.3 versus 12.7 days; p < 0.0001) and lower cost of ICU care (mean postoperative ICU charges, $157,449 versus $198,197; p < 0.0001) with no significant difference in the probability of reintubation (p = 0.7). Immediate extubation was associated with longer operating room turnover time (38.4 versus 46.7 minutes; p = 0.009).
Conclusions:
Immediate extubation was accomplished in 30.4% of neonates undergoing open heart surgery involving cardiopulmonary bypass. Immediate extubation was associated with lesser ICU LOS, postoperative ICU costs, and minimal increase in operating room turnover time, but without an increase in reintubation rates. Low gestational age, preoperative ventilatory support requirement, and prolonged cardiopulmonary bypass time were inversely associated with the ability to accomplish IE.
More Related Videos
04:48Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
05:39Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
Related Concept Videos
01:24Endotracheal Tube Extubation
Procedure
Extubation removes the endotracheal tube (ETT) from the patient on mechanical ventilation. It requires a well-coordinated, multidisciplinary approach involving physicians, nurses, respiratory therapists, and other healthcare professionals....
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:17Endotracheal Intubation II: Nursing Management
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...