A Review of Prolonged Mechanical Ventilation in Pediatric Cardiac Surgery Patients: Risk Factors and Implications

Congenital heart disease (CHD) is a complex common defect in pediatric patients, and definitive treatment is usually cardiac surgery, especially for diseases with complex aetiology (ie, Critical CHD). While significant success has been reported due to improvement in diagnosis and treatment, the risk of mortality is still relatively higher than in the general population. Advances in surgical and post-surgical clinical management continue to increase survival in pediatric patients. However, mechanical ventilation (MV) during and after post-surgical procedures is linked with potential complications that may drive morbidity and mortality. Standard clinical practice dictates weaning patients off MV within the first 24 hours after surgery. However, various factors may increase the risk of extubation failure (EF), reintubation, and prolonged MV (PMV). Generally, PMV has been linked with increased length of pediatric intensive care unit (PICU) stay, morbidity, and higher risk of post-cardiac surgery mortality. The risk of PMV may be either preexisting (preoperative), perioperative/intraoperative, and/or postoperative, with the tendency to define the clinical course and patient outcomes. Monitoring and understanding the physiological dynamics of these risk factors may provide an opportunity for better and improved clinical management, which may translate into better patient outcomes. This review delves into the risk factors of extubation failure, reintubation, and PMV in pediatric cardiac surgery patients with complex (CHD) and the potential preventative measures to improve patients' outcomes.