Clinical and Risk Analytics Associations With Extubation Failure in Children Following Congenital Cardiac Surgery: A Multicenter Retrospective Cohort Study, 2017-2020.

Abstract

Objectives: The use of risk analytics indices alongside clinical factors has potential to assist clinicians in identifying children at high risk for extubation failure (EF). We investigated the association of two physiologic risk analytics indices with EF in children receiving mechanical ventilation (MV) after cardiac surgery: the probability of inadequate oxygen delivery (ID o2 ) and inadequate ventilation of carbon dioxide index (IV co2 ). A secondary aim was to evaluate clinical factors associated with EF.

Design: Multicenter retrospective cohort study.

Setting: Eight international pediatric cardiac ICUs.

Patients: Children between 1 month and 12 years old receiving MV for greater than 48 hours following cardiac surgery between January 1, 2017, and December 31, 2020.

Interventions: None.

Measurements and main results: Nine hundred twenty-two children were analyzed with 79 (8.6%) having EF (defined as reintubation within 48 hr). In multivariable analysis of clinical variables, preoperative MV (adjusted odds ratio [aOR], 1.78; 95% CI, 1.08-2.96; p = 0.03), receiving inhaled nitric oxide (iNO) at extubation (aOR, 2.22; 95% CI, 1.13-4.35; p = 0.02), and duration of postoperative MV (aOR, 1.03; 95% CI, 1.00-1.06; p = 0.03) were independently associated with EF. Seven hundred ninety-two patients (86%) had pre-extubation ID o2 data, 602 (65%) had pre-extubation IV co2 data, and 600 (65%) had both pre-extubation ID o2 and IV co2 data available. In multivariable analysis including these risk analytics algorithms, patients with either ID o2 greater than or equal to 5 or IV co2 greater than or equal to 50 before extubation had higher odds of EF (aOR, 2.06; 95% CI, 1.08-3.94; p = 0.03).

Conclusions: The addition of risk analytics algorithms evaluating the probability of inadequate systemic oxygen delivery or inadequate ventilation to clinical factors (duration of ventilation or iNO delivery at extubation) is useful in assessing the risk for EF in children recovering from cardiac surgery.