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Risk factors analysis for extubation failure following mandibular distraction osteogenesis in infants with Pierre
Wenmin Yang1, Yingqiu Cui2, Feiyan Chen1
1Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Insights
Postoperative pneumonia increases extubation failure risk in infants with Pierre Robin sequence (PRS) undergoing mandibular distraction osteogenesis. Early identification and management of pneumonia are crucial for successful extubation outcomes.
Area of Science:
- Craniofacial Surgery
- Pediatric Critical Care
- Respiratory Management
Background:
- Mandibular distraction osteogenesis is a key treatment for infants with Pierre Robin sequence (PRS).
- Limited data exists on risk factors for postoperative extubation failure (EF) in this population.
- Understanding these risks is vital for improving patient outcomes.
Purpose of the Study:
- To identify risk factors for extubation failure (EF) in infants with PRS post-mandibular distraction osteogenesis.
- To explore the association between EF and clinical outcomes in these infants.
Main Methods:
- Retrospective cohort study of 135 infants with PRS undergoing mandibular distraction osteogenesis (Jan 2020-Dec 2023).
- Extubation failure defined as need for non-invasive ventilation or reintubation within 24 hours.
- Multivariate logistic regression and univariable analyses were used to identify risk factors and clinical outcome associations.
Main Results:
- 20% (27/135) of infants experienced extubation failure (EF).
- Postoperative pneumonia was an independent risk factor for EF (OR 5.25, p<0.05).
- Infants with EF had significantly longer mechanical ventilation, PICU, and hospital stays.
Conclusions:
- Postoperative pneumonia is significantly associated with increased extubation failure risk in PRS infants.
- Further prospective studies are recommended to evaluate targeted pneumonia screening and airway resistance assessment to reduce EF.
- This research highlights the importance of vigilant respiratory monitoring and management in PRS patients.
Background:
Mandibular distraction osteogenesis is an important therapeutic approach for infants with Pierre Robin sequence (PRS). There is a lack of data describing risk factors for postoperative extubation failure (EF) in these infants. We aimed to identify risk factors for EF in infants with PRS and to explore the association between EF and clinical outcomes.
Methods:
A retrospective cohort study was carried out on infants with PRS who received mandibular distraction osteogenesis at our facility from January 2020 to December 2023. Extubation failure was defined as the need for non-invasive ventilation or reintubation within 24 h of extubation. Multivariate logistic regression analysis was performed to explore the risk factors for EF. Univariable statistical analysis was performed to determine associations between EF and clinical outcomes.
Results:
Of 135 included infants, 27 (20.0%) experienced EF. In the logistic regression analysis, postoperative pneumonia was independently associated with EF (p = 0.029). Compared to those without pneumonia, patients with postoperative pneumonia had a odds ratio (OR) of 5.25 for EF (95% CI, 1.18-23.28; p < 0.05). Mandibular distraction length, laryngeal edema, and inflammatory markers (WBC, CRP, temperature) were not associated with EF. Infants who failed extubation had longer durations of mechanical ventilation [5 days (IQR 4-7) vs. 4 days (IQR 4-5), p < 0.001], longer PICU lengths of stay [9 days (IQR 8-13) vs. 6 days (IQR 5-6), p < 0.001], and longer hospital lengths of stay [18 days (IQR 14-22) vs. 15 days (IQR 13-17), p = 0.001] than successfully extubated infants.
Conclusions:
Postoperative pneumonia is associated with an increased risk of failing extubation in infants with PRS. Prospective studies are needed to evaluate whether screening for postoperative pneumonia and evaluating airway resistance before extubation can reduce the risk of EF.
