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Updated: Nov 3, 2025
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Early extubation strategy after congenital heart surgery: 1-year single-centre experience
Lyudmil Simeonov1, Dimitar Pechilkov1, Anna Kaneva1
1Pediatric Cardiology Department, National Cardiology Hospital, Sofia, Bulgaria.
Insights
Early extubation in infants after cardiac surgery shortens ICU and hospital stays without increasing mortality. Malnutrition and prolonged cardiopulmonary bypass are key risk factors for failed breathing trials.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Extubation Strategies
Background:
- Implementing a protocol-driven early extubation strategy in post-operative pediatric cardiac surgical patients.
- Assessing the initial experience and identifying risk factors for failed spontaneous breathing trials (SBTs) within 12 hours post-surgery.
Purpose of the Study:
- To evaluate the effectiveness of an early extubation protocol in pediatric cardiac surgery patients.
- To identify predictors of failed spontaneous breathing trials in this population.
Main Methods:
- Retrospective study of 129 pediatric patients (<18 years) undergoing cardiac surgery.
- Stratification into infants and children, and by ventilation time (early <12h vs. deferred >12h).
- Statistical analysis using Mann-Whitney U-test and logistic regression.
Main Results:
- Early extubation in infants significantly reduced ICU length of stay (4 vs. 6 days) and hospital length of stay (16 vs. 19 days).
- Infants undergoing early extubation had lower re-intubation rates (1% vs. 7%) and mortality (0% vs. 4%).
- Malnourished infants and longer cardiopulmonary bypass times were independently associated with failed SBTs.
Conclusions:
- Early extubation in infants post-cardiac surgery improves outcomes (shorter stays) without increasing morbidity or mortality.
- Nutritional status and cardiopulmonary bypass duration are critical risk factors for failed SBTs in this cohort.
Introduction:
Our aim was to present the initial experience with a protocol-driven early extubation strategy and to identify risk factors associated with failed spontaneous breathing trials within 12 hours after surgery.
Methods:
A single institutional retrospective study of children up to 18 years of age was conducted in post-operative cardiac surgical patients over a 1-year period. A daily spontaneous breathing trial protocol was used to assess patients' readiness for extubation. The study population (n = 129) was stratified into two age groups: infants (n = 84) and children (n = 45), and further stratified according to ventilation time: early extubation (ventilation time less than 12 h, n = 86) and deferred extubation (ventilation time more than 12 h, n = 43). Mann-Whitney U-test and binomial logistic regression were used for statistical analysis.
Results:
Early extubated infants had shorter ICU (4 versus 6 days, p = 0.003) and hospital length of stays (16 versus 19 days, p = 0.006), lower re-intubation rates (1 versus 7 patients, p = 0.003), and lower mortality (0 versus. 4 patients, p = 0.01) than deferred extubated infants. There was no significant difference in the studied outcomes in the children group. Malnourished infants and longer cardiopulmonary bypass times were independently associated with failed spontaneous breathing trials within 12 hours after cardiac surgery.
Conclusions:
Early extubated infants after cardiac surgery had shorter ICU and hospital length of stay, without an increase in morbidity and mortality, compared to infants who deferred extubation. Nutritional status and longer cardiopulmonary bypass times were risk factors for failed spontaneous breathing trial.
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