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Published on: February 26, 2021
Extubation Failure in Infants with Modified Blalock-Taussig Shunt: The Incidence, Predictors, and Outcomes
Mohammed Al Ghafri1, Hamid Al Badi2, Safa Al Hadhrami3
1Department of Cardiac Intensive Care Unit,National Heart Center, Royal Hospital, Muscat, Oman.
Insights
Extubation failure occurred in 18.5% of infants after modified Blalock-Taussig shunt (MBTS) surgery. Predictors included longer mechanical ventilation, diaphragmatic paralysis, and low blood pressure, impacting ICU stay.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Neonatology
Background:
- Infants with congenital heart disease often require mechanical ventilation and prolonged intensive care unit (ICU) stays.
- Complex cardiopulmonary complications necessitate careful management post-surgery.
Purpose of the Study:
- To determine the incidence and predictors of tracheal extubation failure in infants undergoing modified Blalock-Taussig shunt (MBTS).
- To evaluate the association between extubation failure and mortality, as well as ICU and hospital length of stay.
Main Methods:
- Retrospective cohort study at a tertiary pediatric cardiac ICU.
- Analysis of demographic and clinical data from 146 infants who underwent MBTS between 2010 and 2019.
- Multivariate analysis to identify statistically significant predictors of extubation failure.
Main Results:
- The incidence of extubation failure was 18.5% (27 infants).
- Extubation failure was associated with longer ICU and hospital stays.
- Positive associations were found with preoperative mechanical ventilation duration, escalated inotropic score, diaphragmatic paralysis, and low systolic blood pressure.
Conclusions:
- The incidence of extubation failure post-MBTS is 18.5%.
- Key predictors include preoperative mechanical ventilation, diaphragmatic paralysis, need for increased inotropic support, and low systolic blood pressure.
- These factors are crucial for identifying high-risk infants and optimizing care.
Objectives:
Infants with congenital heart diseases often require mechanical ventilation and a prolonged intensive care unit (ICU) stay due to complex cardiopulmonary complications. The primary objective of the study was to determine the incidence and predictors of tracheal extubation failure in infants undergoing modified Blalock-Taussig shunt (MBTS). The secondary objective was to evaluate if extubation failure was associated with increased mortality and longer ICU and hospital stays.
Design:
Single-center, retrospective, cohort study.
Setting:
Tertiary center pediatric cardiac ICU.
Participants:
Infants who underwent MBTS between January 2010 and December 2019.
Interventions:
None.
Measurements And Main Results:
The demographic data and details related to the preoperative, intraoperative, and pretracheal extubation clinical conditions in the ICU were compared between the 2 study arms. Statistically significant predictors were analyzed using multivariate analysis. The p value was based on the Student's -t test for continuous variables and the chi-square test for categorical variables. A total of 146 infants were recruited for the study. Extubation failure occurred in 27 infants (18.5%), resulting in longer ICU and hospital stays. Extubation failure was deemed to be positively associated with preoperative mechanical ventilation duration, the need for escalation of the inotropic score, diaphragmatic paralysis, and systolic blood pressure ≤50th percentile at the time of extubation.
Conclusions:
The incidence rate of extubation failure after placement of MBTS was 18.5%. Preoperative mechanical ventilation, diaphragmatic paralysis, the need for escalation of the inotropic score, and systolic blood pressure ≤50th percentile could be considered predictors of extubation failure in these infants.
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