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Updated: Aug 6, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Frequency and determinants of reintubation following pediatric cardiac surgery
Emine Hekim Yılmaz1, Hacer Kamalı2, Halise Zeynep Genç3
1Department of Pediatric Cardiology, University of Health Sciences Türkiye, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye.
Insights
Reintubation after pediatric cardiac surgery is common, affecting 4% of patients. Key risk factors include airway anomalies, genetic syndromes, and surgical complexity, aiding early identification of high-risk infants.
Area of Science:
- Pediatric Cardiac Surgery
- Critical Care Medicine
- Congenital Heart Disease
Background:
- Reintubation is a significant complication following pediatric cardiac surgery.
- It is associated with increased morbidity and prolonged intensive care unit (ICU) stays.
Purpose of the Study:
- To evaluate the incidence of reintubation after pediatric cardiac surgery.
- To identify independent risk factors associated with reintubation in this patient population.
Main Methods:
- Retrospective analysis of pediatric patients undergoing congenital heart surgery across three tertiary centers (January 2023 - January 2025).
- Data collected included demographics, operative details, and ICU parameters.
- Reintubation defined as need within 72 hours of initial extubation; statistical analyses performed to identify predictors.
Main Results:
- The reintubation rate was 4% among 4,000 patients, with most events within 24 hours.
- Independent risk factors identified: airway anomalies, genetic syndromes, newborn status, higher surgical complexity (Risk Adjustment for Congenital Heart Surgery-1 ≥4, TPS-3), pre-extubation ECMO, diaphragm paralysis/vocal cord dysfunction, and prolonged sternal closure.
- Reintubated patients had longer mechanical ventilation and ICU/hospital stays; mortality did not differ.
Conclusions:
- The incidence of reintubation post-pediatric cardiac surgery is substantial.
- Identifying these risk factors allows for early detection of high-risk patients.
- A cautious extubation approach in identified high-risk groups may improve clinical outcomes.
Background:
Reintubation is a significant complication after pediatric cardiac surgery and is associated with increased morbidity and prolonged intensive care unit (ICU) stay. This study aimed to evaluate the incidence of reintubation and to identify the independent risk factors in this patient population.
Methods:
A retrospective analysis was performed across three tertiary centers between January 1, 2023, and January 1, 2025. Pediatric patients undergoing congenital heart surgery and monitored in the cardiac ICU were included. Demographic characteristics, operative details, and intensive care parameters were extracted from medical records. Reintubation was defined as the need for reintubation within 72 hours following initial extubation. Statistical analyses were conducted to determine predictors of reintubation.
Results:
Among 4.000 pediatric cardiac surgery patients, the reintubation rate was 4%, with most events occurring within 24 hours. In a matched cohort of 320 patients, reintubated patients more frequently had airway anomalies, genetic syndromes, newborn status, higher surgical complexity, and technical performance score (TPS)-3 scores. They also experienced longer mechanical ventilation, prolonged ICU and hospital stays. Multivariable analysis showed independent associations between reintubation and airway anomalies, genetic syndromes, newborn status, risk adjustment for congenital heart surgery-1 ≥4, TPS-3, pre-extubation extracorporeal membrane oxygenation support, diaphragm paralysis or vocal cord dysfunction, and sternal closure ≥2 days. Mortality did not differ between groups.
Conclusion:
The incidence of reintubation after pediatric cardiac surgery remains relatively high, with multifactorial underlying causes. The identification of these potential risk factors may facilitate the detection of high-risk patients following cardiac surgery and contribute to improved clinical outcomes by ensuring a more cautious approach to extubation in these groups.
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