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High Mortality Rate After Extubation Failure After Pediatric Cardiac Surgery

机译：小儿心脏手术拔管失败后高死亡率

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摘要

The objective of this study was to evaluate the different causes of extubation failure and the consequent mortality rates in a pediatric population after cardiac surgery. We studied 184 consecutive patients with a median age of 9 months (range, 0–165). In 158 patients, extubation was successful (group A). Nine patients were reintubated for upper airway obstruction and finally extubated successfully (group B). Seventeen patients were reintubated for cardiorespiratory failure, finally leading to death in 11 of 17 patients (65%) (group C). Group B patients were younger and had a longer intubation period compared to group A patients. Group C patients had more reoperations (30% vs 4% in group A patients, p < 0.001), a lower PaO2 on admission at the intensive care unit as well as just prior to extubation, a lower base deficit before extubation, and needed more inotropic support during their stay in the intensive care unit. We conclude that extubation failure after pediatric cardiac surgery due to cardiorespiratory failure is a bad prognostic sign. Patients with high inotropic support and a low PaO2 prior to extubation are especially at risk and probably need careful evaluation before final extubation.
机译：这项研究的目的是评估心脏手术后小儿拔管失败的各种原因以及由此引起的死亡率。我们研究了184位中位年龄为9个月（0-165岁）的患者。在158例患者中，拔管成功（A组）。 9名患者因上呼吸道阻塞而再次插管，最后成功拔管（B组）。因心肺功能衰竭而重新插管了17例患者，最终导致17例患者中的11例（65％）死亡（C组）。与A组患者相比，B组患者更年轻，插管时间更长。 C组患者的再手术次数较多（A组患者为30％，而A组患者为4％，p <0.001），重症监护病房以及拔管前入院时PaO2 较低，拔管前基础欠缺较低，并且在重症监护病房期间需要更多的正性肌支持。我们得出的结论是，由于心肺衰竭而导致的小儿心脏手术后拔管失败是不良的预后征兆。拔管前具有高肌力支持和低PaO2 的患者尤其危险，可能需要在拔管前仔细评估。

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