Extubation Failure in Neonates Following Congenital Cardiac Surgery: Multicenter Retrospective Cohort, 2017-2020.

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Daniel L Hames, Qalab Abbas, Ahmed Asfari, Santiago Borasino, J Wesley Diddle, Avihu Z Gazit, Stuart Lipsitz, Amanda Marshall, Katherine Reise, Luciana Rodriguez Guerineau, Joshua S Wolovits, Joshua W Salvin
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引用次数: 0

Abstract

Objectives: Extubation failure (EF) in neonates recovering from congenital cardiac surgery is associated with morbidity and mortality. Adding continuous physiologic monitoring data and risk analytics algorithms to clinical factors has the potential to assist clinicians in identifying those neonates at high risk for EF. We aimed to evaluate the association of two physiologic risk analytics algorithms evaluating the probability of inadequate delivery of oxygen index (IDo2) and inadequate ventilation of carbon dioxide index (IVco2) with EF in neonates receiving mechanical ventilation (MV) after cardiac surgery. A secondary aim was to evaluate the clinical factors associated with EF.

Design: Multicenter retrospective cohort study.

Setting: Eight international pediatric cardiac ICUs.

Patients: Neonates (age < 1 mo at the time of surgery) receiving MV for longer than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.

Interventions: None.

Measurements and main results: Data from 736 neonates were analyzed with 102 (13.9%) having EF (defined as reintubation within 48 hr of extubation). In multivariable analysis (odds ratio [OR] and 95% CI), preoperative respiratory support (OR, 1.72 [95% CI, 1.11-2.67]) was associated with greater odds of EF. In all, 611 neonates had pre-extubation IDo2 data and 478 neonates had both pre-extubation IDo2 and IVco2 data. In multivariable analysis of patients with both pre-extubation IDo2 and IVco2 data, single ventricle anatomy (OR, 2.50 [95% CI, 1.27-4.92]) and high IDo2 (≥ 25) or high IVco2 (≥ 50) in the 2 hours preceding extubation (OR, 1.77 [95% CI, 1.01-3.12]) were associated with greater odds of EF.

Conclusions: In this 2017-2020 cohort, EF is high in post-cardiac surgery neonates receiving at least 48 hours of MV. The IDo2 and IVco2 algorithms may be useful in assessing risk of EF in such neonates.

先天性心脏手术后新生儿拔管失败:多中心回顾性队列,2017-2020。
目的:先天性心脏手术后新生儿拔管失败(EF)与发病率和死亡率相关。将持续的生理监测数据和风险分析算法添加到临床因素中,有可能帮助临床医生识别那些EF高风险的新生儿。我们旨在评估心脏手术后接受机械通气(MV)的新生儿缺氧指数(IDo2)输送不足和二氧化碳指数(IVco2)通气不足的概率与EF的两种生理风险分析算法的关联。第二个目的是评估与EF相关的临床因素。设计:多中心回顾性队列研究。设置:8个国际儿科心脏icu。患者:2017年1月1日至2020年12月31日期间心脏手术后接受MV超过48小时的新生儿(手术时小于1个月)。干预措施:没有。测量和主要结果:对736例新生儿的数据进行分析,其中102例(13.9%)发生EF(定义为拔管后48小时内再次插管)。在多变量分析中(比值比[OR]和95% CI),术前呼吸支持(OR, 1.72 [95% CI, 1.11-2.67])与较高的EF发生率相关。总共有611名新生儿有拔管前IDo2数据,478名新生儿同时有拔管前IDo2和IVco2数据。在对拔管前IDo2和IVco2数据的患者进行多变量分析时,单心室解剖(OR, 2.50 [95% CI, 1.27-4.92])和拔管前2小时的高IDo2(≥25)或高IVco2(≥50)(OR, 1.77 [95% CI, 1.01-3.12])与EF的较高几率相关。结论:在2017-2020年队列中,心脏手术后接受至少48小时MV的新生儿EF较高。IDo2和IVco2算法可能有助于评估这些新生儿EF的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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