Failed extubation in pediatric patients after congenital heart disease surgery

Abstract

Introduction: Extubation failure (EF) is a common complication after congenital heart disease surgery (CHDS), ranging from 6.7% to 22%. There are few publications that identify risk factors associated with EF in these patients. 

Objective: To determine the rate of EF after CHDS and identify risk factors.

Method: A 3 years retrospective chart review of children less than 3 years-old who underwent CHDS with cardiopulmonary bypass (CPB). Preoperative, operative and postoperative data was collected, including cardiac defect and type of surgery repair. 

Results: 242 children after CHDS were studied, with EF rate of 9.9%. Significant risk factor for EF during surgery was deep hypothermic circulatory arrest (DHCA) (p = 0,0043 OR = 3,1) and postoperative was laryngeal stridor (p = 0,0006 OR = 21,6). Down Syndrome and age less than 6 months were identified as independent risk factors. Finally, EF was associated with longer mechanical ventilation and higher incidence of pulmonary infections. 

Conclusions: Around 10% of extubation trials failed in patients with CHDS and CPB, a rate that is similar to the ones reported in other clinical reviews. In our study, the main risk factors for EF were laryngeal stridor after extubation, DHCA, Down Syndrome and age less than 6 months. The EF was associated with longer mechanical ventilation and lung infection.