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Endotracheal Tube Extubation01:24

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Related Experiment Video

Updated: Mar 9, 2026

A Structured Approach to Extubation in Mechanically Ventilated Rats
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Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis.

Christopher W Mastropietro1, Katherine Cashen2, Lisa M Grimaldi3

  • 1Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.

The Journal of Pediatrics
|January 9, 2017
PubMed
Summary

Extubation failure in neonates after heart surgery occurs in 12% of cases. Uncuffed endotracheal tubes and prolonged sternotomy increase this risk, leading to worse clinical outcomes.

Keywords:
CHDairway extubationcongenital heart defectshypoplastic left heart syndromeneonatal intensive carepostoperative care

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Area of Science:

  • Pediatric Cardiology
  • Neonatal Surgery
  • Critical Care Medicine

Background:

  • Extubation failure is a significant complication in neonates post-cardiac surgery.
  • Identifying risk factors is crucial for improving patient outcomes.

Purpose of the Study:

  • To determine the incidence of extubation failure in neonates undergoing congenital heart disease surgery.
  • To identify independent risk factors associated with extubation failure.
  • To assess the impact of extubation failure on clinical outcomes.

Main Methods:

  • Prospective observational study across 7 US centers in 2015.
  • Enrolled 283 neonates ≤30 days old undergoing cardiac surgery.
  • Extubation failure defined as reintubation within 72 hours; risk factors analyzed using multivariable logistic regression.

Main Results:

  • 12% (35/283) of neonates experienced extubation failure.
  • Independent risk factors for failure included uncuffed endotracheal tubes (OR 4.6) and open sternotomy ≥4 days (OR 4.8).
  • Extubation failure independently predicted worse clinical outcomes (OR 5.1).

Conclusions:

  • Extubation failure complicates 12% of neonatal congenital heart surgery cases.
  • Uncuffed endotracheal tubes and prolonged open sternotomy are modifiable risk factors.
  • Preventing extubation failure is critical for improving clinical outcomes in this vulnerable population.