Predictive Factors of Prolonged Mechanical Ventilation After Complete Atrioventricular Septal Defect Surgery

Area of Science:

• Pediatric Cardiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• Prolonged mechanical ventilation is a significant complication following complete atrioventricular septal defect (AVSD) repair in infants.
• This complication leads to extended intensive care unit (ICU) and hospital stays, increasing healthcare burden.
• Identifying predictive factors is crucial for optimizing patient management and outcomes.

Purpose of the Study:

• To evaluate perioperative predictors of prolonged mechanical ventilation (≥24 hours) after complete AVSD repair in infants.
• To explore the utility of Brixia scores for early risk stratification in this patient population.
• To identify modifiable factors for reducing ventilation duration.

Main Methods:

• Retrospective review of 129 infants (<12 months) undergoing complete AVSD repair, excluding heterotaxy and airway abnormalities.
• Collection of demographic, perioperative, P/F ratio, imaging, and echocardiographic data.
• Multivariable analysis to identify factors associated with prolonged mechanical ventilation.

Main Results:

• Patients with prolonged ventilation had a significantly lower post-cardiopulmonary bypass P/F ratio (102.0 vs 172.5, P=.048).
• Multivariable analysis identified preoperative Brixia scores and 24-hour postoperative fluid balance as significant predictors of prolonged mechanical ventilation.
• Lower P/F ratios indicate potential for increased ventilation needs.

Conclusions:

• Perioperative factors effectively identify infants at higher risk for prolonged ventilation post-AVSD repair.
• Preoperative Brixia scores and P/F ratios serve as valuable early predictors.
• Postoperative fluid management is a critical, modifiable factor to reduce the duration of mechanical ventilation.