Respiratory care of pediatric patients requiring prolonged intubation after cardiac surgery.

Pediatric patients requiring intubation more than 4 days after cardiac surgery can experience many respiratory and other problems. We found that 48 of 264 pediatric patients could not be extubated within 4 days after open-heart surgery because PaO2 was less than 75 torr and PaCO2 was over 45 torr on an inspired oxygen fraction of 0.4. Most of the 48 patients were under 12 months old, had pulmonary hypertension and/or complex cardiac anomalies, and were not hemodynamically stable and/or fully conscious. The intensity of long-term intubation was attributed to cardiovascular or respiratory complications and multiple organ failure. At the time of extubation, water infusion was maintained below 80 ml/kg X day and positive water balance below 15 ml/kg X day. Calories and amino acid were maintained over 70 kcal/kg X day and 1.5 g/kg X day, respectively.