Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center
Objectives: We studied these predictors at a single cardiac center.
Methods: A retrospective cohort study was carried out after obtaining approval from the institutional review board. All patients (age, 0-14 years) who underwent congenital heart disease (CHD) surgery from January 2014 to June 2016 were included. Prolonged mechanical ventilation (PMV) was defined as greater than 72 hours of ventilation.
Results: A total of 257 patients were included, among whom 219 (85.2%) were intubated for greater than 72 hours and 38 (14.8%) were intubated for ≥72 hours. Age (29.9 versus 11.95 years), weight (9.6 versus 5.9 kg), cross-clamp time (CCT) (53.6 versus 71.8 min), cardiopulmonary bypass time (CBP) (80.98 versus 124.36 min), length of stay in the pediatric intensive care unit (PICU) (10.4 versus 27.2 days), infection (12.8% versus 42.1%), open sternum (0.9% versus 13.2%), re-intubation (19.2% versus 39.5%), pulmonary hypertension (10.9% versus 31.6%), and impaired heart function (10.1% versus 23.7%) were associated with PMV. In terms of Risk Adjustment in Congenital Heart Surgery (RACHS) classification, only patients with RACHS 4 (18.4%) were associated with the risk for PMV.
Conclusions: Age, weight, CBP, CCT, pulmonary hypertension, impaired cardiac function, and sepsis are risk factors for PMV. These factors should be considered when deciding surgery and in providing PICU care.
Saudi Med J 2019; Vol. 40 (4): 367-371
How to cite this article:
Alrddadi SM, Morsy MM, Albakri JK, Mohammed MA, Alnajjar GA, Fawaz MM, et al. Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center. Saudi Med J. 2019 Apr;40(4):367-371. doi: 10.15537/smj.2019.4.23682.
Sauthier M, Rose L, Jouvet P. Pediatric prolonged mechanical ventilation: Considerations for definitional criteria. Respir Care 2017; 62: 49-53.
Tabib A, Abrishami SE, Mahdavi M, Mortezaeian H, Totonchi Z. Predictors of prolonged mechanical ventilation in pediatric patients after cardiac surgery for congenital heart disease. Res Cardiovasc Med 2016; 5: e30391.
Szekely A, Sapi E, Kiraly L, Szatmari A, Dinya E. Intraoperative and postoperative risk factors for prolonged mechanical ventilation after pediatric cardiac surgery. Paediatr Anaesth 2006; 16: 1166-1175.
Shi S, Zhao Z, Liu X, Shu Q, Tan L, Lin R, et al. Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants. Chest 2008; 134: 768-774.
Shu Q, Tan LH, Wu LJ, Zhang ZW, Zhu XK, Li JH, et al. [The risk factors of failed extubation after cardiac surgery in infants]. Zhonghua Yi Xue Za Zhi 2003; 83: 1787-1790.
Ip P, Chiu CS, Cheung YF. Risk factors prolonging ventilation in young children after cardiac surgery: Impact of noninfectious pulmonary complications. Pediatr Crit Care Med 2002; 3: 269-274.
Polito A, Patorno E, Costello JM, Salvin JW, Emani SM, Rajagopal S, et al. Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery. Pediatr Crit Care Med 2011; 12: e122-e126.
Roodpeyma S, Hekmat M, Dordkhar M, Rafieyian S, Hashemi A. A prospective observational study of paediatric cardiac surgery outcomes in a postoperative intensive care unit in Iran. J Pak Med Assoc 2013; 63: 55-59.
Davis S, Worley S, Mee RB, Harrison AM. Factors associated with early extubation after cardiac surgery in young children. Pediatr Crit Care Med 2004; 5: 63-68.
Harrison AM, Cox AC, Davis S, Piedmonte M, Drummond-Webb JJ, Mee RB. Failed extubation after cardiac surgery in young children: Prevalence, pathogenesis, and risk factors. Pediatr Crit Care Med 2002; 3: 148-152.
Barash PG, Lescovich F, Katz JD, Talner NS, Stansel HC, Jr. Early extubation following pediatric cardiothoracic operation: a viable alternative. Ann Thorac Surg 1980; 29: 228-233.
Schuller JL, Bovill JG, Nijveld A, Patrick MR, Marcelletti C. Early extubation of the trachea after open heart surgery for congenital heart disease. A review of 3 years’ experience. Br J Anaesth 1984; 56: 1101-1108.
Dunning J, Au J, Kalkat M, Levine A. A validated rule for predicting patients who require prolonged ventilation post cardiac surgery. Eur J Cardiothorac Surg 2003; 24: 270-276.
Mittnacht AJ, Thanjan M, Srivastava S, Joashi U, Bodian C, Hossain S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg 2008; 136: 88-93.
Nasser BA, Mesned AR, Mohamad T, Kabbani MS. Incidence and causes of prolonged mechanical ventilation in children with Down syndrome undergoing cardiac surgery. J Saudi Heart Assoc 2018; 30: 247-253.
Garcia-Montes JA, Calderon-Colmenero J, Casanova M, Zarco E, Fernandez dlR, Buendia A. Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Arch Cardiol Mex 2005; 75: 402-407.
Jenkins KJ, Gauvreau K, Newburger JW, Spray TL, Moller JH, Iezzoni LI. Consensus-based method for risk adjustment for surgery for congenital heart disease. J Thorac Cardiovasc Surg 2002; 123: 110-118.
Jenkins KJ, Gauvreau K. Center-specific differences in mortality: preliminary analyses using the Risk Adjustment in Congenital Heart Surgery (RACHS-1) method. J Thorac Cardiovasc Surg 2002; 124: 97-104.
Jenkins KJ. Risk adjustment for congenital heart surgery: the RACHS-1 method. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2004; 7: 180-184.
Monteverde E, Fernandez A, Poterala R, Vidal N, Siaba SA, Castelani P, et al. Characterization of pediatric patients receiving prolonged mechanical ventilation. Pediatr Crit Care Med 2011; 12: e287-e291.
Traiber C, Piva JP, Fritsher CC, Garcia PC, Lago PM, Trotta EA, et al. Profile and consequences of children requiring prolonged mechanical ventilation in three Brazilian pediatric intensive care units. Pediatr Crit Care Med 2009; 10: 375-380.
- There are currently no refbacks.
Saudi Medical Journal is copyright under the Berne Convention and the International Copyright Convention. Saudi Medical Journal is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Readers may copy, distribute, and display the work for non-commercial purposes with the proper citation of the original work. Electronic ISSN 1658-3175. Print ISSN 0379-5284.