Measuring Critical Care Unit Performance Using a Postoperative Mechanical Ventilation Quality Metric

Werho, David K.; Fisk, Anna C; Yeh, Justin; Rooney, Sydney; Wilkes, R D; Shin, Andrew; Zhang, Wenying; Banerjee, Mousumi; Gaies, Michael

doi:10.1016/j.athoracsur.2022.11.026

The Annals of Thoracic Surgery

2024

DOI: 10.1016/j.athoracsur.2022.11.026

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Measuring Critical Care Unit Performance Using a Postoperative Mechanical Ventilation Quality Metric

David K. Werho¹,

Anna C Fisk²,

Justin Yeh³

et al.

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2024

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Cited by 3 publications

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“…Mechanical ventilation is common following pediatric cardiovascular surgery, and extubation is an important clinical milestone in a patient’s postoperative course (1). Prolonged mechanical ventilation is associated with adverse clinical outcomes and there is interest in moving toward earlier extubation after cardiovascular surgery whenever feasible (2–4).…”

mentioning

confidence: 99%

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

Wilson

Gunsaulus

Owens

et al. 2023

Pediatric Critical Care Medicine

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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.

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confidence: 99%

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

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Utility of Mechanical Ventilation Duration as a Pediatric Cardiac Intensive Care Unit Quality Metric: Are We There Yet?

Sengupta¹,

Nathan²

2024

The Annals of Thoracic Surgery

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Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery

Kim,

Baskar,

Janson

et al. 2024

The Annals of Thoracic Surgery

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Measuring Critical Care Unit Performance Using a Postoperative Mechanical Ventilation Quality Metric

Cited by 3 publications

References 27 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

Utility of Mechanical Ventilation Duration as a Pediatric Cardiac Intensive Care Unit Quality Metric: Are We There Yet?

Epidemiology of Postoperative Junctional Ectopic Tachycardia in Infants Undergoing Cardiac Surgery

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