Prolonged Mechanical Ventilation and Extubation Failure in Children and Adolescents Undergoing Cardiac Surgery.

Abstract

Introduction: Mechanical ventilation (MV) is one of the factors that may be associated with postoperative complications of cardiac surgeries. This study aimed to verify the clinical and biological factors related to prolonged MV and extubation failure in children and adolescents submitted to cardiac surgeries.

Method: This retrospective cohort included all patients aged between 0 and 15 years at the Unidade de Recuperação Cardio-Torácica Pediátrica who were submitted to the first extubation after cardiac surgery. Those tracheostomized and under MV before the surgery or who suffered accidental extubation were excluded. The following data was collected - age, weight, and sex; body mass index (BMI); heart disease; surgical severity (Risk Adjustment for Congenital Heart Surgery-1); hospitalization period and length of stay at intensive care unit; MV, cardiopulmonary bypass, and anoxia duration; use of continuous sedation (midazolam and/or fentanyl); pulmonary hypertension; nitric oxide use; Down syndrome, extubation site, and failure. The outcomes were prolonged MV and extubation failure.

Results: A total of 233 patients were included - 79 (33.9%) aged below 12 months, 47 (20.2%) had Down syndrome, and 215 (92.3%) presented low BMI. Down syndrome patients and those under continuous sedation in the immediate postoperative period presented a higher risk of prolonged MV (P<0.001). Moreover, patients aged below 12 months (P=0.048) and those under prolonged MV (P=0.006) presented the highest risk of extubation failure.

Conclusion: Patients with continuous sedation or Down syndrome required longer MV. In addition, children younger than 12 months or under prolonged MV presented a high extubation failure rate.