High mortality rate after extubation failure after pediatric cardiac surgery

被引:34
作者
Ten Harkel, ADJ
van der Vorst, MMJ
Hazekamp, MG
Ottenkamp, J
机构
[1] Erasmus MC Sophia, Dept Pediat Cardiol, NL-3015 GJ Rotterdam, Netherlands
[2] Kuwait Univ, Fac Med, Dept Pediat, Kuwait, Kuwait
[3] Leiden Univ, Med Ctr, Dept Cardiothorac Surg, Leiden, Netherlands
[4] Leiden Univ, Med Ctr, Dept Pediat Cardiol, Leiden, Netherlands
关键词
cardiac surgery; pediatric; reintubation; cardiorespiratory failure; upper airway obstruction;
D O I
10.1007/s00246-005-09-6-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The objective of this study was to evaluate the different causes of extubation failure and the consequent mortality rates in a pediatric population after cardiac surgery. We studied 184 consecutive patients with a median age of 9 months (range, 0-165). In 158 patients, extubation was successful (group A). Nine patients were reintubated for upper airway obstruction and finally extubated successfully (group B). Seventeen patients were reintubated for cardiorespiratory failure, finally leading to death in 11 of 17 patients (65%) (group C). Group B patients were younger and had a longer intubation period compared to group A patients. Group C patients had more reoperations (30% vs 4% in group A patients, p < 0.001), a lower PaO2 on admission at the intensive care unit as well as just prior to extubation, a lower base deficit before extubation, and needed more inotropic support during their stay in the intensive care unit. We conclude that extubation failure after pediatric cardiac surgery due to cardiorespiratory failure is a bad prognostic sign. Patients with high inotropic support and a low PaO2 prior to extubation are especially at risk and probably need careful evaluation before final extubation.
引用
收藏
页码:756 / 761
页数:6
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