Hanson Amy E, Herrmann Jeremy L, Abu-Sultaneh Samer, Murphy Lee D, Mastropietro Christopher W
Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Indiana University School of Medicine, Section of Congenital Cardiac Surgery, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.
World J Pediatr Congenit Heart Surg. 2025 Jan;16(1):37-45. doi: 10.1177/21501351241269869. Epub 2024 Oct 3.
Extubation failure and its associated complications are not uncommon after pediatric cardiac surgery, especially in neonates and young infants. We aimed to identify the frequency, etiologies, and clinical characteristics associated with extubation failure after cardiac surgery in neonates and young infants. We conducted a single center prospective observational study of patients ≤180 days undergoing cardiac surgery between June 2022 and May 2023 with at least one extubation attempt. Patients who failed extubation, defined as reintubation within 72 h of first extubation attempt, were compared with patients extubated successfully using χ, Fisher exact, or Wilcoxon rank-sum tests as appropriate. We prospectively enrolled 132 patients who met inclusion criteria, of which 11 (8.3%) failed extubation. Median time to reintubation was 25.5 h (range 0.4-55.8). Extubation failures occurring within 12 h (n = 4) were attributed to upper airway obstruction or apnea, whereas extubation failures occurring between 12 and 72 h (n = 7) were more likely to be due to intrinsic lung disease or cardiac dysfunction. Underlying genetic anomalies, greater weight relative to baseline at extubation, or receiving positive end expiratory pressure (PEEP) > 5 cmHO at extubation were significantly associated with extubation failure. In this study of neonates and young infants recovering from cardiac surgery, etiologies of early versus later extubation failure involved different pathophysiology. We also identified weight relative to baseline and PEEP at extubation as possible modifiable targets for future investigations of extubation failure in this patient population.
小儿心脏手术后拔管失败及其相关并发症并不少见，尤其是在新生儿和小婴儿中。我们旨在确定新生儿和小婴儿心脏手术后拔管失败的发生率、病因及临床特征。我们对2022年6月至2023年5月期间接受心脏手术且至少有一次拔管尝试、年龄≤180天的患者进行了单中心前瞻性观察研究。将拔管失败的患者（定义为首次拔管尝试后72小时内再次插管）与成功拔管的患者进行比较，根据情况使用χ²检验、Fisher精确检验或Wilcoxon秩和检验。我们前瞻性纳入了132例符合纳入标准的患者，其中11例（8.3%）拔管失败。再次插管的中位时间为25.5小时（范围0.4 - 55.8小时）。12小时内发生的拔管失败（n = 4）归因于上呼吸道梗阻或呼吸暂停，而12至72小时之间发生的拔管失败（n = 7）更可能是由于肺部内在疾病或心脏功能障碍。潜在的遗传异常、拔管时相对于基线体重增加以及拔管时接受呼气末正压（PEEP）>5 cmH₂O与拔管失败显著相关。在这项关于心脏手术后恢复的新生儿和小婴儿的研究中，早期与晚期拔管失败的病因涉及不同的病理生理学。我们还确定了相对于基线的体重和拔管时的PEEP是该患者群体未来拔管失败研究中可能的可改变目标。
