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Prolonged Mechanical Ventilation after Cardiac Surgery in Young Children: Incidence, Etiology, and Risk Factors

Department of Pediatric Critical Care Medicine, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH., Daviss1{at}ccf.org

Amy C. Cox, MD

Department of General Pediatrics, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH.

Marion Piedmonte, MS

Department of Biostatistics and Epidemiology, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH.

Jonathan J. Drummond-Webb, MD

Department of Cardiology and Congenital Heart Surgery, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH.

Roger B. B. Mee, MB, ChB, FRACS

Department of Cardiology and Congenital Heart Surgery, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH.

A. Marc Harrison, MD, FAAP

Department of Pediatric Critical Care Medicine, Division of Pediatrics, Children’s Hospital at the Cleveland Clinic, Cleveland, OH.

Children undergoing congenital heart surgery require postoperative mechanical ventilation. Despite recent advances, prolonged mechanical ventilation (PMV) is necessary in some patients and may increase the risk of post-operative complications. The purpose of this study was to identify incidence and risk factors for PMV. The authors performed a retrospective chart review. They defined PMV as ventilation longer than 48 hours. Mixed-effects linear regression models were used to assess the relationship between each factor and duration of mechanical ventilation. Separate models were developed for preoperative, intraoperative, and postoperative periods. To determine the extent to which a combination of risk factors would predict PMV, the most significant variables were adopted to fit a model using number of risk factors to predict PMV. Two hundred twelve children 36 months were included. Eleven (5.2%) children died perioperatively. Of the patients, 72.6% (143/197) were extubated by 48 hours. Age < 6 months, perioperative infection, inotrope use > 48 hours, total parenteral nutrition use, and failed extubation were associated with PMV. PMV occurred in 28% of the patients in this study. The presence of 2 risk factors predicted PMV with a sensitivity of 86% and a specificity of 94%.

Key Words: extubation failure • mechanical ventilation • cardiac surgery • pediatric intensive care unit • post-operative care • congenital heart disease

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