Incidence, Predictors, and Outcomes of Extubation Failure in Children After Orthotopic Heart Transplantation: A Single-Center Experience

Gupta, Punkaj; Chow, Vinca; Gossett, Jeffrey M.; Yeh, Justin; Roth, Stephen J.

doi:10.1007/s00246-014-1003-6

Cited by 10 publications

(12 citation statements)

References 19 publications

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“…A similar result was found in the study by Gaies et al, ( 25 ) who found that patients with longer ICU stays had a higher risk of developing FE. Additionally, Gupta et al ( 20 ) found that the length of stay in the ICU and the duration of the hospital stay were associated with FE. Additionally, Cruces et al, ( 16 ) in Chile, found an association between time on MV and the length of stay in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for extubation failure in the intensive care unit

Silva-Cruz¹,

Velarde-Jacay²,

Carreazo³

et al. 2018

Revista Brasileira De Terapia Intensiva

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ObjectiveTo determine the risk factors for extubation failure in the intensive care unit.MethodsThe present case-control study was conducted in an intensive care unit. Failed extubations were used as cases, while successful extubations were used as controls. Extubation failure was defined as reintubation being required within the first 48 hours of extubation.ResultsOut of a total of 956 patients who were admitted to the intensive care unit, 826 were subjected to mechanical ventilation (86%). There were 30 failed extubations and 120 successful extubations. The proportion of failed extubations was 5.32%. The risk factors found for failed extubations were a prolonged length of mechanical ventilation of greater than 7 days (OR = 3.84, 95%CI = 1.01 - 14.56, p = 0.04), time in the intensive care unit (OR = 1.04, 95%CI = 1.00 - 1.09, p = 0.03) and the use of sedatives for longer than 5 days (OR = 4.81, 95%CI = 1.28 - 18.02; p = 0.02).ConclusionPediatric patients on mechanical ventilation were at greater risk of failed extubation if they spent more time in the intensive care unit and if they were subjected to prolonged mechanical ventilation (longer than 7 days) or greater amounts of sedative use.

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Section: Discussionmentioning

confidence: 99%

Risk factors for extubation failure in the intensive care unit

Silva-Cruz¹,

Velarde-Jacay²,

Carreazo³

et al. 2018

Revista Brasileira De Terapia Intensiva

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“…Some authors (3, 11) used a different time period to define extubation failure (< 24 or for up to 96 hr after extubation), while others include use of noninvasive positive pressure ventilation as a criterion for failure (12, 18, 19). Our definition of extubation failure as need for reintubation within 48 hours is consistent with that in several other previous studies from both cardiac and general pediatric critical care populations (4–6).…”

Section: Discussionmentioning

confidence: 99%

Clinical Epidemiology of Extubation Failure in the Pediatric Cardiac ICU

Gaies¹,

Tabbutt

Schwartz

et al. 2015

Pediatric Critical Care Medicine

113

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Objective To describe the clinical epidemiology of extubation failure in a multicenter cohort of patients treated in pediatric cardiac ICUs. Design Retrospective cohort study using prospectively collected clinical registry data. Setting Pediatric Cardiac Critical Care Consortium registry. Patients All patients admitted to the CICU at Pediatric Cardiac Critical Care Consortium hospitals. Interventions None. Measurements and Main Results Analysis of all mechanical ventilation episodes in the registry from October 1, 2013, to July 31, 2014. The primary outcome of extubation failure was reintubation less than 48 hours after planned extubation. Repeated-measures analysis using generalized estimating equations to account for within patient and center correlation was performed to identify risk factors for extubation failure. Adjusted extubation failure rates for each hospital were calculated using logistic regression controlling for patient factors. Of 1,734 mechanical ventilation episodes (1,478 patients at eight hospitals) ending in a planned extubation, there were 100 extubation failures (5.8%). In multivariable analysis, only longer duration of mechanical ventilation was significantly associated with extubation failure (p = 0.01); the failure rate was 4% when ventilated less than 24 hours, 9% after 24 hours, and 13% after 7 days. For 503 patients intubated and extubated in the cardiac operating room, 15 patients (3%) failed extubation within 48 hours (12 within 24 hr). Case-mix-adjusted extubation failure rates ranged from 1.1% to 9.8% across hospitals. Patients failing extubation had greater median cardiac ICU length of stay (15 vs 3 d; p < 0.001) and in-hospital mortality (7.9 vs 1.2%; p < 0.001). Conclusions Though extubation failure is uncommon overall, there may be opportunities to improve extubation readiness assessment in patients ventilated more than 24 hours. These data suggest that extubation in the operating room after cardiac surgery can be done with a low failure rate. We observed variation in extubation failure rates across hospitals, and future investigation must elucidate the optimal strategies of high-performing centers to reduce ventilation time while limiting extubation failures.

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“…[1][2][3][4][5] Others continue mechanical ventilation (MV) postoperatively in the intensive care unit (ICU) due to risks associated with untimely extubation. [6][7][8] Identifying which children can be successfully removed from MV in the OR after cardiac surgery is a complex decision process. Research that unravels the factors contributing to the risk of extubation failure could affect outcomes and reduce costs.…”

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confidence: 99%