Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA.
Emory University School of Medicine, Atlanta, GA, USA.
Cardiol Young. 2023 Feb;33(2):201-207. doi: 10.1017/S1047951122000427. Epub 2022 Mar 3.
Following cardiac surgery, infants often remain endotracheally intubated upon arrival to the cardiac ICU. High-flow nasal cannula and non-invasive positive pressure ventilation are used to support patients following extubation. There are limited data on the superiority of either mode to prevent extubation failure.
We conducted a single-centre retrospective study for infants (<1 year) and/or <10 kg who underwent cardiac surgery between 3/2019-3/2020. Data included patient and clinical characteristics and operative variables. The study aimed to compare high-flow nasal cannula versus non-invasive positive pressure ventilation following extubation and their association with extubation failure. Secondarily, we examined risk factors associated with extubation failure.
There were 424 patients who met inclusion criteria, 320 (75%) were extubated to high-flow nasal cannula, 104 (25%) to non-invasive positive pressure ventilation, and 64 patients (15%) failed extubation. The high-flow nasal cannula group had lower rates of extubation failure (11%, versus 29%, = 0.001). Infants failing extubation were younger and had higher STAT score ( < 0.05). Compared to high-flow nasal cannula, non-invasive positive pressure ventilation patients were at 3.30 times higher odds of failing extubation after adjusting for patient factors ( < 0.0001).
Extubation failure after cardiac surgery occurs in smaller, younger infants, and those with higher risk surgical procedures. Patients extubated to non-invasive positive pressure ventilation had 3.30 higher odds to fail extubation than patients extubated to high-flow nasal cannula. The optimal mode of respiratory support in this patient population is unknown.
心脏手术后，婴儿通常在到达心脏 ICU 时仍保持气管插管。高流量鼻导管和无创正压通气用于在拔管后支持患者。关于两种模式中哪一种更能预防拔管失败的数据有限。
我们进行了一项单中心回顾性研究，纳入了 2019 年 3 月至 2020 年 3 月期间接受心脏手术的婴儿（<1 岁）和/或体重<10kg 的患者。数据包括患者和临床特征以及手术变量。该研究旨在比较拔管后高流量鼻导管与无创正压通气，并分析其与拔管失败的关系。其次，我们还研究了与拔管失败相关的危险因素。
共有 424 名符合纳入标准的患者，其中 320 名（75%）患者被拔管至高流量鼻导管，104 名（25%）患者被拔管至无创正压通气，64 名（15%）患者拔管失败。高流量鼻导管组的拔管失败率较低（11%， versus 29%， = 0.001）。拔管失败的婴儿年龄较小，STAT 评分较高（<0.05）。与高流量鼻导管相比，调整患者因素后，无创正压通气患者的拔管失败风险高 3.30 倍（<0.0001）。
心脏手术后的拔管失败发生在较小、年龄较小的婴儿，以及那些手术风险较高的婴儿。与高流量鼻导管相比，拔管至无创正压通气的患者发生拔管失败的风险高 3.30 倍。在这种患者人群中，最佳的呼吸支持模式尚不清楚。
