Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction Operation

Scodellaro, Thomas; McKenzie, Jane; d’Udekem, Yves; Butt, Warwick; Namachivayam, Siva P.

doi:10.1097/pcc.0000000000001334

Cited by 13 publications

(12 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A higher proportion of patients with HLHS and patients undergoing the Norwood procedure were seen in the FE group, similar to other reports which also delineate FE as a clinically significant event in patients with single ventricle physiology (5,9,17,18).…”

Section: Discussionsupporting

confidence: 88%

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

Wilson

Gunsaulus

Owens

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

OBJECTIVES: To describe factors associated with failed extubation (FE) in neonates following cardiovascular surgery, and the relationship with clinical outcomes. DESIGN: Retrospective cohort study. SETTING: Twenty-bed pediatric cardiac ICU (PCICU) in an academic tertiary care children’s hospital. PATIENTS: Neonates admitted to the PCICU following cardiac surgery between July 2015 and June 2018. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients who experienced FE were compared with patients who were successfully extubated. Variables associated with FE (p < 0.05) from univariate analysis were considered for inclusion in multivariable logistic regression. Univariate associations of FE with clinical outcomes were also examined. Of 240 patients, 40 (17%) experienced FE. Univariate analyses revealed associations of FE with upper airway (UA) abnormality (25% vs 8%, p = 0.003) and delayed sternal closure (50% vs 24%, p = 0.001). There were weaker associations of FE with hypoplastic left heart syndrome (25% vs 13%, p = 0.04), postoperative ventilation greater than 7 days (33% vs 15%, p = 0.01), Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category 5 operations (38% vs 21%, p = 0.02), and respiratory rate during spontaneous breathing trial (median 42 vs 37 breaths/min, p = 0.01). In multivariable analysis, UA abnormalities (adjusted odds ratio [AOR] 3.5; 95% CI, 1.4–9.0), postoperative ventilation greater than 7 days (AOR 2.3; 95% CI, 1.0–5.2), and STAT category 5 operations (AOR 2.4; 95% CI, 1.1–5.2) were independently associated with FE. FE was also associated with unplanned reoperation/reintervention during hospital course (38% vs 22%, p = 0.04), longer hospitalization (median 29 vs 16.5 d, p < 0.0001), and in-hospital mortality (13% vs 3%, p = 0.02). CONCLUSIONS: FE in neonates occurs relatively commonly following cardiac surgery and is associated with adverse clinical outcomes. Additional data are needed to further optimize periextubation decision-making in patients with multiple clinical factors associated with FE.

show abstract

Section: Discussionsupporting

confidence: 88%

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

Wilson

Gunsaulus

Owens

et al. 2023

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

show abstract

“…En relación con la mortalidad de este grupo de pacientes, Scodellaro y cols. 6 publicaron un aumento de hasta 5 veces de la mortalidad de los pacientes con falla de extubación versus los que no la hicieron. La mortalidad de 7,7 % observada en el presente estudio posterior a la extubación fallida es similar a la obtenida por Gupta y cols.…”

Section: Discussionunclassified

“…En pacientes de Unidades de Cuidados Intensivos (UCI) generales de adultos se ha reportado una asociación estadísticamente significativa entre falla de extubación y mortalidad postoperatoria con un OR de 7,3 (IC 95% 4,6-11,7) 5 . En series recientes de pacientes pediátricos se ha podido determinar que posterior a la operación de Norwood el grupo que presenta falla en la extubación tiene hasta 5 veces más mortalidad que los que no la presentan 6 . En estudios realizados en nuestro…”

Section: Introductionunclassified

Extubación fallida postoperación de Norwood en pacientes con síndrome de hipoplasia de ventrículo izquierdo

et al. 2020

Rev Chil Pediatr

View full text Add to dashboard Cite

En pacientes con Síndrome de Hipoplasia de Ventrículo Izquierdo (SHVI) la primera etapa hacia una fisiología univentricular de Fontan es la operación de Norwood, cuya mortalidad es 10-30%. En estos pacientes la extubación fallida se presenta en un 18% y se ha asociado a aumento de la mortalidad.Objetivo: Describir la frecuencia de extubación fallida y sus factores de riesgo en pacientes con SHVI operados (Norwood).Pacientes y Método: Estudio de casos y controles que incluyó a todos los pacientes con SHVI manejados con cirugía de Norwood en el Hospital Clínico de la Pontificia Universidad Católica (enero-2000 a febrero-2018). Se define como casos a pacientes con falla en la extubación y como controles a los pacientes sin esta complicación. Se registraron variables demográficas, quirúrgicas, y post-quirúrgicas, y se realizó análisis univariado y multivariado (regresión logística) para determinar los factores de riesgo asociados a la falla en la extubación.Resultados: De un total de 107 pacientes, 26 pacientes tuvieron extubación fallida (24,3%). En el análisis univariado los factores asociados a extubación fallida fueron: mayor tiempo de ventilación mecánica postquirúrgico, desarrollar atelectasias, derrame pleural, quilotórax, tener otras comorbilidades respiratorias (apnea y traqueítis), y mayor tiempo de uso de morfina y midazolam. En el análisis multivariado, la presencia de quilotórax, otras comorbilidades respiratorias, y mayor tiempo de uso de midazolam fueron variables asociadas a extubación fallida (p<0,03). La extubación fallida no se asoció a mayor mortalidad.Conclusiones: La presencia de quilotórax, complicaciones respiratorias y uso de midazolam prolongado deben considerarse para definir el momento de la extubación, con el objetivo de evitar su fracaso.

show abstract

“…Withdrawing MV prematurely, however, may exacerbate low cardiac output, trigger life-threatening arrhythmias, and e209 precipitate cardiac arrest (7,8). In addition, extubation failure is associated with longer cardiac ICU (CICU) and hospital stays (9)(10)(11)(12)(13) and increased mortality (9,10,12,13). There is a simultaneous need for precise identification of patients who benefit from either continued MV or extubation to noninvasive ventilation (NIV).…”

mentioning

confidence: 99%

Associations With Extubation Failure and Predictive Value of Risk Analytics Algorithms With Extubation Readiness Tests Following Congenital Cardiac Surgery

Hames

Sleeper

Bullock

et al. 2022

Pediatric Critical Care Medicine

View full text Add to dashboard Cite

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.

show abstract

Extubation Failure Is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction Operation

Cited by 13 publications

References 28 publications

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

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

Extubación fallida postoperación de Norwood en pacientes con síndrome de hipoplasia de ventrículo izquierdo

Associations With Extubation Failure and Predictive Value of Risk Analytics Algorithms With Extubation Readiness Tests Following Congenital Cardiac Surgery

Contact Info

Product

Resources

About