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Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction
Thomas Scodellaro1,2, Jane M McKenzie1,2, Yves d'Udekem2,3,4
1Paediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.
Insights
Extubation failure is common after single ventricle reconstruction surgery, affecting 16.8% of neonates. This complication significantly increases the risk of mortality, highlighting the need for improved care strategies.
Area of Science:
- Pediatric Cardiac Surgery
- Neonatal Intensive Care
- Cardiovascular Research
Background:
- Single ventricle reconstruction surgery is a complex procedure in neonates.
- Extubation failure is a significant postoperative complication with potential adverse outcomes.
Purpose of the Study:
- To determine the prevalence, causes, risk factors, and outcomes of extubation failure after first-stage single ventricle reconstruction.
- To identify potential areas for quality improvement in neonatal postoperative care.
Main Methods:
- Retrospective cohort analysis of neonates undergoing first-stage single ventricle reconstruction.
- Extubation failure defined as reintubation within 48 hours of the initial extubation attempt.
- Data collected from The Royal Children's Hospital, Melbourne, between 2005 and 2014.
Main Results:
- Extubation failure occurred in 16.8% of 137 neonates.
- Male infants had a higher rate of extubation failure (p=0.02).
- Extubation failure was associated with significantly higher intensive care (19.4% vs 3.5%) and in-hospital mortality (30.4% vs 6.1%).
Conclusions:
- A high prevalence of extubation failure exists following first-stage single ventricle reconstruction.
- Extubation failure is linked to substantially worse patient outcomes.
- Opportunities exist for quality assurance initiatives to reduce extubation failure and improve patient outcomes.
Objectives:
To identify the prevalence, causes, risk factors, and outcomes associated with extubation failure following first stage single ventricle reconstruction surgery.
Design:
Retrospective cohort analysis of neonates who underwent a first stage single ventricle reconstruction operation. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt.
Setting:
The Royal Children's Hospital, Melbourne.
Patients:
Data were collected for all infants who underwent a Norwood or Damus-Kaye-Stansel procedure between 2005 and 2014 at our institution.
Interventions:
None.
Measurements And Main Results:
Extubation failure occurred in 23 of 137 neonates (16.8%; 95% CI, 11.0-24.1%) who underwent a trial of extubation. Overall, 42 patients (30.7%) were extubated to room air, 88 (64.2%) to nasal continuous positive airway pressure, and seven (5.1%) to high-flow nasal cannulae, though there was no major difference in extubation failure rates between these three groups (p = 0.37). The median time to reintubation was 16.7 hours (interquartile range, 3.2-35.2), and male infants failed extubation more frequently (63.2% vs 87.0%; p = 0.02), although age, gestation, weight, cardiac diagnosis (hypoplastic left heart syndrome vs other single ventricle conditions), shunt type (modified Blalock-Taussig vs right ventricle-pulmonary artery shunt), intraoperative perfusion times, preextubation mechanical ventilation duration, preextubation acid-base status, and postoperative fluid balance were not related to extubation outcome. Infants who failed extubation had a higher intensive care mortality (19.4% vs 3.5%; p = 0.03) and in-hospital mortality (30.4% vs 6.1%; p < 0.001).
Conclusions:
There is a high prevalence of extubation failure following first stage single ventricle reconstruction, and this is associated with considerably worse patient outcomes. The high prevalence and also the wide variation in rates of extubation failure in reported literature provide with an opportunity for implementation of quality assurance activities to minimize this complication and improve outcomes.
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