[Prolonged endotracheal intubation after open heart surgery under the age of one year]

The aim of this study was to determine the impact of prolonged endotracheal intubation after open heart surgery in neonates and babies with respect to the cardiac diseases most frequently responsible and the reasons for delayed extubation and the related mortality. Intubation was considered to be prolonged if lasting over 48 hours. This was a retrospective study of all cases of open heart surgery performed before one year of age between 1991 and 1996. Prolonged intubation was noted in 43.1% of cases (266/617). The frequency was much higher than in children over 1 year of age: 8.3% (56/725). Truncus arteriosus (93.5%: 29/31), obstructed total anomalous venous drainage (93.3%: 14/15). Taussig-Bing anomaly (83.3%: 5/6), interruption of the aortic arch (78.9%: 15/19), double outlet right ventricle (61.1%: 11/18) and transposition of the great arteries (50.2%: 107/213) were the commonest responsible malformations. The reasons for delayed extubation, often multiple, were established in 222 cases: cardiogenic shock or circulating failure in 155 cases, pulmonary dysfunction in 142 cases, surgical complications in 65 cases and neurological complications in 14 cases. Twelve patients died: 5 of congestive heart failure, 3 of pulmonary hypertension, 2 of septic shock and 1 of diffuse stenosis of the pulmonary veins. The mortality rate was 4.5% (12/266) in cases of prolonged intubation and 5.2% (32/617) for all infants operated during the first year of life. The authors conclude that a large number of infants undergoing open heart surgery undergo prolonged intubation because of their poor preoperative status and the particularly severe effects of cardiopulmonary bypass at this age. However, the associated mortality was low in this series.