Femoral Muscle Volume Change and Postextubation Respiratory Support in Infants After Cardiac Surgery

Area of Science:

• Pediatric critical care medicine
• Cardiovascular surgery
• Respiratory physiology

Background:

• Noninvasive respiratory support aims to reduce extubation failure in infants post-cardiac surgery.
• Accurate stratification of high-risk infants is essential for effective respiratory support.
• Investigating novel predictive markers for post-extubation respiratory support is crucial.

Purpose of the Study:

• To evaluate the predictive capability of femoral ultrasonography for respiratory support requirements in infants following cardiac surgery.
• To assess the utility of the femoral muscle index and its changes in predicting the need for post-extubation respiratory support.

Main Methods:

• Prospective observational study of infants undergoing cardiac surgery requiring prolonged mechanical ventilation (>48 h).
• Femoral ultrasonography performed on pediatric intensive care unit (PICU) admission and pre-extubation.
• Receiver operating characteristic (ROC) curve analysis used to assess the predictive accuracy of femoral muscle index and its change.

Main Results:

• Femoral muscle cross-sectional area (CSA) changes were not significantly different between infants requiring and not requiring respiratory support.
• The femoral muscle index and its percent change showed limited predictive value (ROC-AUC 0.50 and 0.63, respectively).
• Body weight-adjusted tidal volume and breathing frequency were stronger predictors (ROC-AUC 0.81 and 0.72, respectively).

Conclusions:

• Femoral muscle volume and its changes during mechanical ventilation lack meaningful predictive value for post-extubation respiratory support needs in this population.
• Clinical utility of muscle loss assessment via femoral ultrasonography requires further investigation across diverse patient groups and outcomes.