Mastropietro Christopher W, Cashen Katherine, Grimaldi Lisa M, Narayana Gowda Keshava Murty, Piggott Kurt D, Wilhelm Michael, Gradidge Eleanor, Moser Elizabeth A S, Benneyworth Brian D, Costello John M
Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
J Pediatr. 2017 Mar;182:190-196.e4. doi: 10.1016/j.jpeds.2016.12.028. Epub 2017 Jan 4.
To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease.
We conducted a prospective observational study of neonates ≤30 days of age who underwent cardiac surgery at 7 centers within the US in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified with the use of multivariable logistic regression analysis and reported as OR with 95% CIs. Multivariable logistic regression analysis was conducted to examine the relationship between extubation failure and worse clinical outcome, defined as hospital length of stay in the upper 25% or operative mortality.
We enrolled 283 neonates, of whom 35 (12%) failed their first extubation at a median time of 7.5 hours (range 1-70 hours). In a multivariable model, use of uncuffed endotracheal tubes (OR 4.6; 95% CI 1.8-11.6) and open sternotomy of 4 days or more (OR 4.8; 95% CI 1.3-17.1) were associated independently with extubation failure. Accordingly, extubation failure was determined to be an independent risk factor for worse clinical outcome (OR 5.1; 95% CI 2-13).
In this multicenter cohort of neonates who underwent surgery for congenital heart disease, extubation failure occurred in 12% of cases and was associated independently with worse clinical outcome. Use of uncuffed endotracheal tubes and prolonged open sternotomy were identified as independent and potentially modifiable risk factors for the occurrence of this precarious complication.
描述拔管失败的流行病学特征，并确定在接受先天性心脏病手术的多中心新生儿群体中其发生的危险因素。
我们对2015年在美国7个中心接受心脏手术的30日龄及以下新生儿进行了一项前瞻性观察研究。拔管失败定义为首次计划拔管后72小时内再次插管。通过多变量逻辑回归分析确定危险因素，并以95%可信区间的比值比（OR）报告。进行多变量逻辑回归分析以检验拔管失败与更差临床结局之间的关系，更差临床结局定义为住院时间处于前25%或手术死亡率。
我们纳入了283例新生儿，其中35例（12%）首次拔管失败，中位时间为7.5小时（范围1 - 70小时）。在多变量模型中，使用无套囊气管内导管（OR 4.6；95%可信区间1.8 - 11.6）和开胸手术4天或更长时间（OR 4.8；95%可信区间1.3 - 17.1）与拔管失败独立相关。因此，拔管失败被确定为更差临床结局的独立危险因素（OR 5.1；95%可信区间2 - 13）。
在这个接受先天性心脏病手术的多中心新生儿队列中，12%的病例发生了拔管失败，且与更差的临床结局独立相关。使用无套囊气管内导管和延长开胸手术时间被确定为这种危险并发症发生的独立且可能可改变的危险因素。
