Todd Tzanetos Deanna, Bassi Harjot, Furlong-Dillard Jamie, Mastropietro Christopher, Olive Mary, Klugman Darren, Werho David
Pediatric Critical Care Medicine, Norton Children's Hospital, University of Louisville, Louisville, KY, USA.
Rady Children's Hospital, San Diego, CA, USA.
Cardiol Young. 2025 Feb;35(2):332-337. doi: 10.1017/S1047951124036151. Epub 2024 Dec 19.
Extubation failure after neonatal cardiac surgery is associated with increased intensive care unit length of stay, morbidity, and mortality. We performed a quality improvement project to create and implement a peri-extubation bundle, including extubation readiness testing, spontaneous breathing trial, and high-risk criteria identification, using best practices at high-performing centers to decrease neonatal and infant extubation failure by 20% from a baseline of 15.7% to 12.6% over a 2-year period.
Utilising the transparency of the Pediatric Cardiac Critical Care Consortium database, five centres were identified as high performers, having better-than-expected neonatal extubation success rates with the balancing metric of as-expected or better-than-expected mechanical ventilation duration. Structured interviews were conducted with cardiac intensive care unit physician leadership at the identified centers to determine centre-specific extubation practices. Data from those interviews underwent qualitative content analysis which was used to develop a peri-extubation bundle. The bundle was implemented at a single-centre 17-bed cardiac intensive care unit. Extubation failure, defined as reintubation within 48 hours of extubation for anything other than a procedure, ventilator days and bundle compliance was tracked.
There was a 41.4% decrease in extubation failure following bundle implementation (12 failures of 76 extubations pre-implantation; 6 failures of 65 extubations post-implementation). Bundle compliance was 95.4%. There was no difference in ventilator days ( = 0.079) between groups.
Implementation of a peri-extubation bundle created from best practices at high-performing centres reduced extubation failure by 41.4% in neonates and infants undergoing congenital heart surgery.
新生儿心脏手术后拔管失败与重症监护病房住院时间延长、发病率和死亡率增加有关。我们开展了一项质量改进项目，以创建并实施一项拔管前综合措施，包括拔管准备测试、自主呼吸试验和高危标准识别，采用高绩效中心的最佳实践，在两年时间内将新生儿和婴儿拔管失败率从15.7%的基线水平降低20%，降至12.6%。
利用儿科心脏重症监护联盟数据库的透明度，确定了五个中心为高绩效中心，这些中心的新生儿拔管成功率高于预期，且机械通气持续时间达到或优于预期作为平衡指标。对已确定中心的心脏重症监护病房医师负责人进行了结构化访谈，以确定各中心具体的拔管实践。对这些访谈的数据进行了定性内容分析，用于制定拔管前综合措施。该综合措施在一家拥有17张床位的单中心心脏重症监护病房实施。跟踪拔管失败情况（定义为拔管后48小时内非因手术原因再次插管）、呼吸机使用天数和综合措施依从性。
实施综合措施后拔管失败率下降了41.4%（实施前76次拔管中有12次失败；实施后65次拔管中有6次失败）。综合措施依从性为95.4%。两组之间的呼吸机使用天数无差异（P = 0.079）。
采用高绩效中心的最佳实践创建的拔管前综合措施，使接受先天性心脏病手术的新生儿和婴儿的拔管失败率降低了41.4%。
