Related Experiment Video
Updated: Sep 13, 2025
Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model
Published on: May 26, 2023
Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A
Daniel L Hames1,2, Qalab Abbas3, Ahmed Asfari4
1Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA.
Insights
Risk analytics indices, including inadequate oxygen delivery and ventilation, alongside clinical factors, can help identify children at high risk for extubation failure after cardiac surgery. This aids in better patient management and outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Surgery Outcomes
- Mechanical Ventilation Management
Background:
- Extubation failure (EF) is a significant concern in children post-cardiac surgery requiring mechanical ventilation (MV).
- Identifying high-risk patients is crucial for optimizing care and preventing adverse events.
- Clinical factors alone may not fully capture the risk of EF.
Purpose of the Study:
- To investigate the association of two physiologic risk analytics indices, probability of inadequate oxygen delivery (ID o2) and inadequate ventilation of carbon dioxide index (IV co2), with EF in pediatric cardiac surgery patients.
- To evaluate clinical factors independently associated with EF in this population.
Main Methods:
- Multicenter retrospective cohort study involving eight international pediatric cardiac intensive care units.
- Analysis of 922 children (1 month to 12 years) receiving MV >48 hours post-cardiac surgery.
- Utilized multivariable analysis to assess the impact of clinical variables and risk analytics indices (ID o2, IV co2) on EF.
Main Results:
- Extubation failure occurred in 8.6% of patients (n=79).
- Preoperative MV, inhaled nitric oxide (iNO) at extubation, and duration of postoperative MV were independently associated with EF.
- Patients with ID o2 ≥5 or IV co2 ≥50 before extubation had significantly higher odds of EF.
Conclusions:
- The integration of risk analytics algorithms (ID o2, IV co2) with clinical factors improves the assessment of EF risk in children post-cardiac surgery.
- These indices provide valuable insights beyond traditional clinical assessments.
- This approach can aid clinicians in proactive risk stratification and management strategies.
Objectives:
The use of risk analytics indices alongside clinical factors has potential to assist clinicians in identifying children at high risk for extubation failure (EF). We investigated the association of two physiologic risk analytics indices with EF in children receiving mechanical ventilation (MV) after cardiac surgery: the probability of inadequate oxygen delivery (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ). A secondary aim was to evaluate clinical factors associated with EF.
Design:
Multicenter retrospective cohort study.
Setting:
Eight international pediatric cardiac ICUs.
Patients:
Children between 1 month and 12 years old receiving MV for greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.
Interventions:
None.
Measurements And Main Results:
Nine hundred twenty-two children were analyzed with 79 (8.6%) having EF (defined as reintubation within 48 hr). In multivariable analysis of clinical variables, preoperative MV (adjusted odds ratio [aOR], 1.78; 95% CI, 1.08-2.96; p = 0.03), receiving inhaled nitric oxide (iNO) at extubation (aOR, 2.22; 95% CI, 1.13-4.35; p = 0.02), and duration of postoperative MV (aOR, 1.03; 95% CI, 1.00-1.06; p = 0.03) were independently associated with EF. Seven hundred ninety-two patients (86%) had pre-extubation ID o2 data, 602 (65%) had pre-extubation IV co2 data, and 600 (65%) had both pre-extubation ID o2 and IV co2 data available. In multivariable analysis including these risk analytics algorithms, patients with either ID o2 greater than or equal to 5 or IV co2 greater than or equal to 50 before extubation had higher odds of EF (aOR, 2.06; 95% CI, 1.08-3.94; p = 0.03).
Conclusions:
The addition of risk analytics algorithms evaluating the probability of inadequate systemic oxygen delivery or inadequate ventilation to clinical factors (duration of ventilation or iNO delivery at extubation) is useful in assessing the risk for EF in children recovering from cardiac surgery.
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....
01:17Endotracheal 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...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:26Endoscopic Studies II: Thoracocentesis
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...