Background and objectives:Extubation failure (EF) after cardiac surgery is associated with poorer outcomes. Approximately 50% of children with Down syndrome (DS) have congenital heart disease. Our primary aim was to describe the frequency of EF and identify risk factors for its occurrence in a population of patients with DS after cardiac surgery. Secondary aims were to describe complications, length of hospital stay and mortality rates.
MethodsA retrospective case control study, in a national reference congenital heart disease repair center of Chile.Include all infants 0-12 months old with DS who were admitted to pediatric intensive care unit after cardiac surgery between January 2010 and November 2020. Patients with EF (cases) were matched 1:1 with children who did not fail their extubation (controls) using the following criteria: age at surgery, sex and type of congenital heart disease.
ResultsOverall, 27/226 (11,3%) failed their rst extubation. In the rst analysis, before matching of cases and controls was made, we found association between EF and younger age (3.8 months vs 5 months; p = 0.003) and presence of coarctation of the aorta (p = 0.005). In the case-control univariate analysis, we found association between an increased cardiothoracic ratio (CTR) (p = 0.03; OR 5 (95% CI 1.6-16.7) for a CTR > 0.59) and marked hypotonia (27% vs 0%; p = 0.01) with the risk of EF. No differences were found in ventilatory management.
ConclusionsEF is associated with younger age, presence of aortic coarctation, rising in CTR and hypotonia.Recognition of these factors may be helpful when planning extubation for these patients.This study has the limitations inherent in a single-center, retrospective cohort study. In addition, given the selected group of patients included with a rare event, we obtained a limited cohort for the analysis. We also found limitations at the time of registering the variables. The absence of weaning and extubation protocols can affect the analysis because they are not homogeneous, as well as the lack of registration and objectivity of other variables, such as hypotonia.
ConclusionsThis is the rst study in the literature that analyses risk factors for EF in patients with DS after cardiac surgery. Based on the ndings, these factors could be taken into consideration when planning extubation. These are low-cost and simple to evaluate at the patient's admission and include age, a chest radiography, and perform a neurological examination for marked hypotonia. Other factors, such as a preoperative airway diagnostic evaluation, ventilatory management strategies, and sedatives and narcotics dosing, require further studies before setting them up as a recommendation.This study, although it presents limitations, provides relevant information as a basis for planning innovative studies with a more considerable number of patients that allow identifying with greater certainty the risk factors associated with EF, contributing to optimize the postoperative care of patients with DS undergoing cardiac surgery.
