AI Article Synopsis
- Extubation failure in children after cardiac surgery is linked to younger age, male sex, and more complex procedures, with a rate of 8% reintubation observed in the study.
- The study found that traditional assessments for extubation readiness have low effectiveness in predicting reintubation risk, particularly with a sensitivity of only 23.8%.
- Adding a new index for oxygen delivery improved sensitivity but decreased overall test accuracy, highlighting the need for better predictive tools in managing extubation.
Article 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058191 | PMC |
| http://dx.doi.org/10.1097/PCC.0000000000002912 | DOI Listing |
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