Perioperative Risk Factors for Prolonged Mechanical Ventilation Following Cardiac Surgery in Neonates and Young Infants

Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease

“…One possible reason for these differences could be differences in institutional protocols in the preoperative and ICU management of pediatric patients after cardiac surgery. However, some factors such as age, pulmonary hypertension, infections particularly respiratory infections and heart failure were common among different investigations (1)(2)(3)(4)(5)(6)(7)(8)(9).In a similar study by Shi et al (3) nosocomial pneumonia, fluid imbalance and low cardiac output syndromes were independently associated with PMV (MV ≥ 72 hours). Marwali et.…”

“…The incidence of PMV in Shi et al (3) and Szekely et al (1) were 35.4% and 25% respectively, and in the study by Polito et al (6) 11% of pediatric patients undergoing cardiac surgery remained intubated for more than seven days.Recently, early extubation is being considered as a safe strategy after cardiac surgery in many centers (1-13). However, there are conflicting data regarding the definition and the predictors of PMV in different studies (1)(2)(3)(4)(5)(6)(7)(8)(9). It is shown that even after complex heart surgeries, extubation is usually achievable before 72 hours (1).…”

“…However, these patients are prone to pulmonary hypertensive crisis after surgery which may be due to hypoperfusion of pulmonary tissue during cardiopulmonary bypass .The pulmonary compliance will decrease in patients with pulmonary hypertension crisis and prone them to respiratory complications and PMV (4,5).Cardiac dysfunction is another important predictor for PMV after congenital heart disease surgery. (2, 3) Many children with congenital heart anomalies, particularly those with complex ones have limited cardiac reserve which may get worse during CPB (22).The occurrence of heart failure and low output state syndrome after congenital heart surgery is multi factorial and depends on the severity of cardiac dysfunction before surgery, aortic cross clamp time, CPB time and myocardial preservation measures during surgery (1,3). With persistence, the heart failure clinical manifestations, and discontinuing the inotrope support will be difficult and using multiple and high dose inotropes might induce more myocardial damages (1,3,22).…”

“…The duration of mechanical ventilation (MV) is one of the most important clinical factors which predicts outcomes in pediatric cardiac surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).The improvement in MV protocols and early extubation shortens the intensive care unit (ICU) stay and results in less complications and improved outcomes (14)(15)(16) .Hence, there is a need to identify and quantify clinical predictors of prolonged mechanical ventilation (PMV).Predictors of PMV after pediatric cardiac surgery are investigated in several studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Parameters such as the clinical condition of the patients and underlying disorders, factors related to surgical and anesthetic techniques, the postoperative ICU management protocols and certain postoperative complications including renal failure can influence the length of intubation (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

Tracheostomy in Infants With Congenital Heart Disease: A Nationwide Population-Based Study in Taiwan

“…Cumulative mortality incidence in infants with congenital heart disease (CHD) with and without tracheostomy (log-rank, P Ͻ .001). HR ϭ hazard ratio CHD ϭ congenital heart disease NI ϭ neuromuscular impairment CAA ϭ congenital airway anomaly bation after cardiac surgery, 18,20,29,30 and comorbid chronic health conditions. 6,10 Although the effect was not significant, comorbidity with prematurity seemed to decrease the probability of tracheostomy placement (adjusted OR 0.89, 95% CI 0.58 -1.37), which may be due to the co-linearity between such factors as prematurity and chronic lung disease.…”