Extubation after cardiothoracic surgery in neonates, children, and young adults: One year of institutional experience

Objective: Describe risk factors associated with successful and early extubation in the pediatric cardiac intensive care unit. Design: Retrospective chart review. Setting. University hospital, cardiac intensive care unit. Measurements and Main Results: Review of 212 consecutive surgical admissions from January 2003 to January 2004, excluding deaths. Preoperative, intraloperative, and postoperative variables were studied. Successful extubation was defined as no reintubation at any time during the cardiac intensive care unit course and early extubation was defined as mechanical ventilation :524 hrs. Median subject age was 8 months (range, 1 day-25 yrs), with 57% < 1 yr of age and 22% neonates. Fifty-eight (27%) were extubated in the operating room and 122 (58%) were extubated at < 24 hrs (mean, 6.1 : 7.7 hrs). Only seven patients failed extubation: three in the operating room because of upper airway obstruction and four in the cardiac intensive care unit for acute respiratory failure associated with atelectasis (n = 2), ventricular dysfunction (n = 1), and arrhythmia (n = 1). There were no extubation failures in patients extubated > 24 hrs after surgery. A history of prematurity (odds ratio [OR], 5.84, 2.29-14.9; p < .001), base excess (OR, 1.47, 1.27-1.70; p < .001), cardiopulmonary bypass time (OR, 1.01, 1.01 to -1.2; p < .05), and the need for surgical reintervention (OR, 18.29, 2.78 to - 120.07; p < .05) were associated with intubation for > 24 hrs. Conclusion: Extubation without the need for reintubation can be achieved in nearly all children following cardiothoracic surgery. The majority of successful extubations can be achieved within 24 hrs of surgery.