Daniel L Hames1,2, Lynn A Sleeper2,3, Kevin J Bullock4, Eric N Feins5,6, Kimberly I Mills1,2, Peter C Laussen7,8, Joshua W Salvin1,2. 1. Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, MA. 2. Department of Pediatrics, Harvard Medical School, Boston, MA. 3. Department of Cardiology, Boston Children's Hospital, Boston, MA. 4. Department of Respiratory Care, Boston Children's Hospital, Boston, MA. 5. Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA. 6. Department of Surgery, Harvard Medical School, Boston, MA. 7. Department of Anesthesia, Boston Children's Hospital, Boston, MA. 8. Department of Anesthesia, Harvard Medical School, Boston, MA.
Abstract
OBJECTIVES: Extubation failure is associated with morbidity and mortality in children following cardiac surgery. Current extubation readiness tests (ERT) do not consider the nonrespiratory support provided by mechanical ventilation (MV) for children with congenital heart disease. We aimed to identify factors associated with extubation failure in children following cardiac surgery and assess the performance of two risk analytics algorithms for patients undergoing an ERT. DESIGN: Retrospective cohort study. SETTING: CICU at a tertiary-care children's hospital. PATIENTS: Children receiving MV greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six hundred fifty encounters were analyzed with 49 occurrences (8%) of reintubation. Extubation failure occurred most frequently within 6 hours of extubation. On multivariable analysis, younger age (per each 3-mo decrease: odds ratio [OR], 1.06; 95% CI, 1.001-1.12), male sex (OR, 2.02; 95% CI, 1.03-3.97), Society of Thoracic Surgery-European Association for Cardiothoracic Surgery category 5 procedure (p equals to 0.005), and preoperative respiratory support (OR, 2.08; 95% CI, 1.09-3.95) were independently associated with unplanned reintubation. Our institutional ERT had low sensitivity to identify patients at risk for reintubation (23.8%; 95% CI, 9.7-47.6%). The addition of the inadequate delivery of oxygen (IDO2) index to the ERT increased the sensitivity by 19.0% (95% CI, -2.5 to 40.7%; p = 0.05), but the sensitivity remained low and the accuracy of the test dropped by 8.9% (95% CI, 4.7-13.1%; p < 0.01). CONCLUSIONS: Preoperative respiratory support, younger age, and more complex operations are associated with postoperative extubation failure. IDO2 and IVCO2 provide unique cardiorespiratory monitoring parameters during ERTs but require further investigation before being used in clinical evaluation for extubation failure.
OBJECTIVES: Extubation failure is associated with morbidity and mortality in children following cardiac surgery. Current extubation readiness tests (ERT) do not consider the nonrespiratory support provided by mechanical ventilation (MV) for children with congenital heart disease. We aimed to identify factors associated with extubation failure in children following cardiac surgery and assess the performance of two risk analytics algorithms for patients undergoing an ERT. DESIGN: Retrospective cohort study. SETTING: CICU at a tertiary-care children's hospital. PATIENTS: Children receiving MV greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2019. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Six hundred fifty encounters were analyzed with 49 occurrences (8%) of reintubation. Extubation failure occurred most frequently within 6 hours of extubation. On multivariable analysis, younger age (per each 3-mo decrease: odds ratio [OR], 1.06; 95% CI, 1.001-1.12), male sex (OR, 2.02; 95% CI, 1.03-3.97), Society of Thoracic Surgery-European Association for Cardiothoracic Surgery category 5 procedure (p equals to 0.005), and preoperative respiratory support (OR, 2.08; 95% CI, 1.09-3.95) were independently associated with unplanned reintubation. Our institutional ERT had low sensitivity to identify patients at risk for reintubation (23.8%; 95% CI, 9.7-47.6%). The addition of the inadequate delivery of oxygen (IDO2) index to the ERT increased the sensitivity by 19.0% (95% CI, -2.5 to 40.7%; p = 0.05), but the sensitivity remained low and the accuracy of the test dropped by 8.9% (95% CI, 4.7-13.1%; p < 0.01). CONCLUSIONS: Preoperative respiratory support, younger age, and more complex operations are associated with postoperative extubation failure. IDO2 and IVCO2 provide unique cardiorespiratory monitoring parameters during ERTs but require further investigation before being used in clinical evaluation for extubation failure.
Authors: Christoph P Hornik; Xia He; Jeffrey P Jacobs; Jennifer S Li; Robert D B Jaquiss; Marshall L Jacobs; Sean M O'Brien; Eric D Peterson; Sara K Pasquali Journal: Ann Thorac Surg Date: 2011-09-19 Impact factor: 4.330
Authors: Cortney B Foster; Michael C Spaeder; Robert J McCarter; Yao I Cheng; John T Berger Journal: Pediatr Crit Care Med Date: 2013-07 Impact factor: 3.624
Authors: Ryan A Romans; Steven M Schwartz; John M Costello; Nikhil K Chanani; Parthak Prodhan; Avihu Z Gazit; Andrew H Smith; David S Cooper; Jeffrey Alten; Kshitij P Mistry; Wenying Zhang; Janet E Donohue; Michael Gaies Journal: Pediatr Crit Care Med Date: 2017-10 Impact factor: 3.624
Authors: Sarah Tabbutt; Jennifer Schuette; Wenying Zhang; Jeffrey Alten; Janet Donohue; J William Gaynor; Nancy Ghanayem; Jeffrey Jacobs; Sara K Pasquali; Ravi Thiagarajan; Justin B Dimick; Mousumi Banerjee; David Cooper; Michael Gaies Journal: Pediatr Crit Care Med Date: 2019-02 Impact factor: 3.624
Authors: Michael G Gaies; James G Gurney; Alberta H Yen; Michelle L Napoli; Robert J Gajarski; Richard G Ohye; John R Charpie; Jennifer C Hirsch Journal: Pediatr Crit Care Med Date: 2010-03 Impact factor: 3.624
Authors: Elizabeth C Ciociola; Karan R Kumar; Kanecia O Zimmerman; Elizabeth J Thompson; Melissa Harward; Laura N Sullivan; Joseph W Turek; Christoph P Hornik Journal: Cardiol Young Date: 2019-11-27 Impact factor: 1.093