The Royal Children's Hospital Melbourne, Paediatric Intensive Care Unit, Melbourne, Australia.
Murdoch Children's Research Institute, Melbourne, Australia.
Pediatr Cardiol. 2021 Jun;42(5):1149-1156. doi: 10.1007/s00246-021-02593-2. Epub 2021 Apr 17.
Extubation failure (EF) following neonatal cardiac surgery is associated with increased mortality. Neonates who experienced EF twice or more (recurrent EF) may have worse outcomes than those who have a single EF or no-EF. The aims of this study are to investigate the in hospital mortality for neonates with recurrent EF compared to those with single or no-EF, and determine factors associated with recurrent EF. Neonates' ≤ 28 days who underwent cardiac surgery from January 2008 to December 2019 were included. EF was defined as unplanned reintubation within 72 h after a planned extubation. 1187 (18 recurrent EF, 84 single EF and 1085 no-EF) neonates were included. Recurrent EF occurred in 18 (17.6%) of 102 neonates undergoing a second extubation. The median time (IQR) to reintubation after the first and second extubations were similar, being 20.9 (3.3-45.2) versus 19.4 (5.5-47) h. The reason for a second-time EF was respiratory in 39% and cardiovascular in 33%. Recurrent EF and single EF was associated with increased mortality (odds ratio, 95% confidence interval (CI) 23.5, 6.9-79.9) and (odds ratio, 95% CI 5.2, 2.3-12.0) compared to no-EF. Based on the final model with risk adjustment, predicted mortality was 29.0% in recurrent EF, 6.5% in single EF, and 1.2% in no-EF. First-time EF due to cardiovascular compromise was associated with recurrent EF (odds ratio, 95% CI 3.1, 1.0-9.7). This study confirmed that patients with recurrent EF have a high morality. Neonates with a cardiovascular reason for first-time EF are more likely to have a recurrent EF than those with other causes.
新生儿心脏手术后拔管失败（EF）与死亡率增加有关。经历过 EF 两次或更多次（复发性 EF）的新生儿可能比单次 EF 或无 EF 的新生儿预后更差。本研究旨在探讨与单次 EF 或无 EF 相比，复发性 EF 新生儿的住院死亡率，并确定与复发性 EF 相关的因素。纳入 2008 年 1 月至 2019 年 12 月期间接受心脏手术的≤28 天新生儿。EF 定义为计划拔管后 72 小时内计划重新插管。共纳入 1187 例（18 例复发性 EF，84 例单发性 EF 和 1085 例无 EF）新生儿。102 例再次拔管的新生儿中有 18 例（17.6%）发生复发性 EF。首次和第二次拔管后再插管的中位数时间（IQR）相似，分别为 20.9（3.3-45.2）和 19.4（5.5-47）小时。第二次 EF 的原因是呼吸占 39%，心血管占 33%。与无 EF 相比，复发性 EF 和单发性 EF 与死亡率增加相关（比值比，95%置信区间（CI）23.5，6.9-79.9）和（比值比，95%CI 5.2，2.3-12.0）。在进行风险调整的最终模型基础上，复发性 EF 的预测死亡率为 29.0%，单发性 EF 为 6.5%，无 EF 为 1.2%。由于心血管原因导致的首次 EF 与复发性 EF 相关（比值比，95%CI 3.1，1.0-9.7）。本研究证实，复发性 EF 患者的死亡率较高。因心血管原因导致首次 EF 的新生儿比因其他原因导致首次 EF 的新生儿更有可能发生复发性 EF。
