Descriptors of Failed Extubation in Norwood Patients Using Physiologic Data Streaming

Abstract

Objective: To evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic pro le of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure.Methods: Single-center, retrospective analysis. Extubation events were collected from January 2016 until July 2021. Extubation failure was de ned as the need for re-intubation within 48 hours of extubation. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.Results: The analysis included 311 extubations. The extubation failure rate was 10%. According to univariate analyses, failed extubations were preceded by higher respiratory rates (p=0.029), lower endtidal CO2 (p=0.009), lower pH (p=0.043), lower serum bicarbonate (p=0.030), and lower partial pressure of O2 (p=0.022). In the rst 10 minutes after extubation, the failed events were characterized by lower arterial (p=0.028) and cerebral NIRS (p=0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 hours post-extubation (p=0.027). In multivariate analysis, vocal cord anomaly, cerebral NIRS at 10 minutes post-extubation, renal NIRS at pre-extubation and postextubation, and end-tidal CO2 at pre-extubation remained as signi cant co-variates.Conclusions: Oximetric indices before, in the 10 minutes immediately after, and 2 hours after extubation and vocal cords paralysis are associated with failed extubation events in patients with parallel circulation.

Factors associated with renal oxygen extraction in mechanically ventilated children after the Norwood operation: insights from high fidelity hemodynamic data

“…Increased oxygen extraction has been demonstrated to increased morbidity and mortality, with oxygen extraction of 30 to 40 being demonstrated as a period at which the risk of morbidity such as impaired neurodevelopment, acute kidney injury, hepatic insu ciency, necrotizing enterocolitis, and cardiac arrest increase [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

Failed Extubation in Neonates After Cardiac Surgery: A Single-Center, Retrospective Study

“…Although findings suggest the limited ability of traditional parameters in isolation to predict the likelihood of extubation success, machine learning could provide the clinician a means with which to synthesize the multitude of available variables to guide extubation decision-making. Our group and others have explored machine learning and evaluation of information available through physiologic data streaming as means by which better evaluate candidacy for extubation (21)(22)(23). Future directions may include the extraction of more granular data and computer modeling to create and validate useful models of extubation readiness.…”

Factors associated with central venous pressure in children with parallel circulation after the Norwood operation: insights from high resolution hemodynamic data

“…This leads to higher morbidity and mortality, as well [2][3][4]. Management of these patients thus requires thorough understanding of the principles that underpin this circulation, how to adequately monitor these patients, as well as the impacts of various clinical interventions in this circulation [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The role of central venous pressures and what factors are associated with central venous pressure in patients with parallel circulation have not been well described.…”