Predictors for mortality after prolonged mechanical ventilation after cardiac surgery in children.
OBJECTIVE
To identify early mortality-associated clinical risk factors preceding, during, and after cardiac surgery in children.


METHODS
Of the 722 children admitted to our pediatric intensive care unit (PICU) from January 1992 to January 1997 after repair of congenital heart defects, 70 required 48 hours or more of mechanical ventilation. Their clinical records were analyzed for perioperative predictors of mortality.


RESULTS
The children's ages were 3.6 +/- 4.1 years (range, 4 d-16 y). The overall mortality was 5.9%. Eleven of the 70 children (15.7%) who required mechanical ventilation for 48 hours or more did not survive compared with 30 of the 652 (4.6%) children ventilated for less than 48 hours. The preoperative predictors identified as being significantly associated with increased mortality were younger age (P <.05) and the presence of congestive heart failure (P <.01). The main cause of early postoperative mortality was multiorgan dysfunction (9 children, 81.8%), whereas septic complications also were responsible for late (< 1 wk postoperatively) death (the other 2 children, 17.2%).


CONCLUSIONS
Younger age and congestive heart failure were the main preoperative predictors of mortality. Multiorgan dysfunction and septic complication were predictive of an increased risk for death after cardiac surgery. These factors should be investigated in greater depth to assist in guiding aggressive therapeutic approaches for combating early signs of organ system dysfunction and infectious complications in these high-risk patients.
Ben-Abraham
Ron
R
Department of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Efrati
Ori
O
Mishali
Dudi
D
Yulia
Fuxman
F
Vardi
Amir
A
Barzilay
Zohar
Z
Paret
Gideon
G
D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007557:Israel / Q000453:epidemiology; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D019990:Perioperative Care; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors