Abstract 18508: Extubation Failure is Associated With Increased Mortality Following First Stage Single Ventricle Reconstruction
Introduction: Extubation following first stage single ventricle reconstruction surgery presents a considerable challenge to the patient and clinician. We aimed to identify the incidence, risk factors and outcomes associated with extubation failure for these patients within our institution.
Methods: A retrospective cohort study was undertaken of all neonates who underwent a Norwood or Damus-Kaye-Stansel procedure between 1 January 2005 and 31 December 2014. Extubation failure was defined as endotracheal reintubation within 48 hours of first extubation attempt.
Results: Extubation failure occurred in 23 of 137 (16.8%, 95%CI 11.0-24.1%) neonates who underwent a trial of extubation. Overall, 42 (30.7%) patients were extubated to room air, 88 (64.2%) to nasal CPAP and 7 (5.1%) high-flow nasal cannulae, but there was no significant difference in extubation failure rates between the three forms of support (p=0.37). The median time to reintubation was 16.7 hours (IQR 3.2-35.2) and failure was due to cardiorespiratory impairment in 14 cases and other causes in 9 (upper airway obstruction=6, sepsis=3). Male infants failed extubation more frequently (63.2% vs 87.0%, p=0.02), whilst age, weight, cardiac diagnosis, shunt type, intraoperative perfusion times, time to extubation, postoperative fluid balance and pre-extubation blood gas results were not related to extubation outcome. Reintubation within 48 hours was significantly associated with an increased total duration of mechanical ventilation (5.7 days vs 11.4, p<0.001), intensive care length of stay (8.9 days vs 16.7, p=0.02), intensive care mortality (3.5% vs 19.4%, p=0.03) and in-hospital mortality (6.1% vs 30.4%, p<0.001). Children with a cardiorespiratory impairment causing extubation failure had a higher mortality compared to other causes (57.1% vs. 0%, p=0.007).
Conclusions: There is a high incidence of extubation failure following first stage single ventricle reconstruction and this is associated with considerably worse patient outcomes. Cardiorespiratory impairment as a cause for extubation failure is associated with high mortality.
Author Disclosures: T. Scodellaro: None. J. McKenzie: None. Y. d’Udekem: None. W. Butt: None. S. Namachivayam: None.
- © 2016 by American Heart Association, Inc.