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Failed Extubation After Primary Repair of Type C Esophageal Atresia: Frequency and Risk Factors
Donna C Koo1, P Nina Scalise1, Megan Z Chiu1
1Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Fegan 3, Boston, MA, 02115, United States.
Insights
Extubation failure occurred in 10% of newborns after esophageal atresia and tracheoesophageal fistula (EA/TEF) repair, with congenital anomalies being a significant risk factor. Individualized extubation strategies are recommended.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Malformations
Background:
- Reintubation post-esophageal atresia and tracheoesophageal fistula (EA/TEF) repair may increase anastomotic injury risk.
- Newborns may require reintubation due to extubation failure.
- Understanding extubation failure in EA/TEF is crucial for optimizing patient outcomes.
Purpose of the Study:
- To determine the frequency of extubation failure in newborns undergoing primary type C EA/TEF repair.
- To identify risk factors predicting extubation failure.
- To evaluate the impact of extubation timing and non-invasive support modalities on outcomes.
Main Methods:
- Single-center retrospective review of newborns with type C EA/TEF (2010-2020).
- Comparison of patient characteristics and outcomes between successfully extubated and reintubated groups.
- Analysis of early (POD 0-1) versus delayed (POD ≥2) extubation and various non-invasive ventilation strategies.
Main Results:
- Ten percent (7/69) of newborns required reintubation.
- Concomitant congenital malformations significantly increased the likelihood of reintubation (14x).
- No significant difference in reintubation, anastomotic leak, or stricture rates between early and delayed extubation groups. Successful extubation was more common with room air or nasal cannula support.
Conclusions:
- Extubation failure in 10% of EA/TEF repair patients is linked to multiple congenital anomalies.
- Tailored extubation strategies are essential for improving outcomes in this vulnerable population.
Purpose:
Reintubation after esophageal atresia and tracheoesophageal fistula (EA/TEF) repair is believed to increase the risk of anastomotic injury. However, some newborns fail initial extubation and require reintubation. This study explores the frequency and risk factors predictive of extubation failure in newborns after primary type C EA/TEF repair. We further evaluate the effect of extubation management strategies, such as the timing of extubation and the use of supportive non-invasive modalities.
Methods:
We conducted a single-center review of newborns with type C EA/TEF between 2010 and 2020. Patient characteristics and perioperative outcomes between successfully extubated and reintubated newborns were compared. Patients who underwent early extubation (postoperative day [POD] 0-1) were compared to those who underwent delayed extubation (POD ≥2). Patients were divided by the modality of noninvasive positive pressure ventilation to which they were extubated and outcomes were compared between groups.
Results:
Sixty-nine newborns underwent primary type C EA/TEF repair. Seven newborns (10 %) required a total of 10 reintubations. Patients who failed extubation had more concomitant congenital malformations, and newborns with congenital anomalies were 14 times more likely to require reintubation. There was no significant difference in reintubation, anastomotic leak, or stricture rate between those who underwent early versus delayed extubation. Newborns who were successfully extubated were more likely to be extubated to room air or nasal cannula.
Conclusion:
Extubation failure occurred in 10% of patients and was significantly associated with the presence of multiple congenital anomalies. Individualized extubation strategies may optimize outcomes.
Level Of Evidence:
III.
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