Risk Factors And Prognosis For Extubation Failure After Pediatric Heart Surgery

Objective:To explore the prevalence of and risk factors of extubation failure after pediatric CHD surgery and provide clinical basis for proper and accurate MV treatment strategy and prevention of extubation failure in CHD postoperative care.Methods:A retrospective analysis had been made on the patients in the PICU who received the cardiac surgery during January 1^st 2016 to January 1^st2017.The prevalence and etiology of extubation failure were reviewed.Extubation failure was defined as reintubation within 72 hours.Demographic,clinical data about perioperative,intraoperative,postoperative were retrospectively collected.Multiple logistic regression models were used to identify the risk factors for extubation failure.We analysis the clinical outcome through the total MV time,the PICU length of stay,hospital length of stay and dead in hospital.Results:Extubation failure occurred in 30 of 257 cases?11.7%;95%confidence interval:8.2%-16%?.The age and weight at surgery of extubation failure group were lower than those of the successful extubation group?P<0.05?.The children younger than 6 months and less than 5 kg at surgery were more likely to occur extubation failure,which was statistically significant.?P<0.05?.Children failed their first extubation attempt at a median time of 17 hours after the attempt?rang 1-70 hours?,and 18?60.0%?cases were failed in 0-24 hours,7?23.3%?cases were failed in 24-48 hours,5?16.7%?cases were failed in 48-72 hours.Early extubation failure had 18cases?60%?,and late extubation failure had 12 cases?40%?.Nineteen patients?63.3%?successfully extubation when they attempt to extubation again,and 11 patients?36.7%?repeatedly failed.Among the reasons for extubation failure,there were 9 cases?30%?for lung or thoracic complications,4 cases?13.3%?for airway malformations,8 cases?26.6%?for laryngeal edema,and 9 cases for hemodynamic instability?30%?.Laryngeal edema was easier to occur in children of younger and lower weight.All of laryngeal edema cases were early extubation failure who occurred within 0-24 hours after initial attempt extubation,the difference was statistically significant?P<0.05?.Single factor analysis showed Down syndrome,airway malformation,ventilation before surgery,degree of RACHS-1,time of CPB,prolonged MV and VAP before extubation after cardiac surgery were associated with extubation failure?P<0.05?.The multivariable analysis identified younger than 6 months,Down syndrome,airway malformation,MV longer than 7 days were the independent risk factors for extubation failure.Clinical outcomes were significantly worse in patients who failed extubation.Children who failed their first extubation had significantly longer MV,PICU and hospital stays than children who were extubated successfully,and mortality was significantly greater in children who failed their first extubation?P<0.05?.The total MV time and PICU length of stay of children with repeated extubation failure were significantly longer than those with only one extubation failure?P<0.05?.There was no significant difference in total hospital stay and hospital mortality?P>0.05?.Conclusions:The prevalence of extubation failure was high in children after cardiac surgery;Younger age,lower weight,Down syndrome,airway malformation,ventilation before surgery,high degree of RACHS-1,long time of CPB,prolonged MV and VAP before extubation after cardiac surgery were associated with extubation failure;Younger than 6 months,Down syndrome,airway malformation and MV longer than 7 days were the independent risk factors for extubation failure.The children who extubation failure had worse prognosis.Extubation failure cause longer MV times,longer hospital stay,and Increased In-hospital mortality.CHD patients with risk factors for extubation failure should be accurately assessed and pre-intervened in order to reduce the occurrence of extubation failure and improve the prognosis of children.