Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants.
BACKGROUND
Prolonged mechanical ventilation (PMV) after cardiac surgery in children is associated with a high postoperative morbidity and mortality, as well as increased ICU and hospital resource utilization. Little has been done to identify the predictors of PMV in neonates and young infants. This study was performed to evaluate the perioperative risk factors for PMV in neonates and young infants undergoing cardiac surgery.


METHODS
Clinical records of 172 consecutive children aged < or = 3 months were reviewed. PMV was defined as mechanical ventilation (MV) > or = 72 h following operation. After univariate analysis, a stepwise logistic regression analysis was used to evaluate the independent risk factors for PMV following cardiac surgery. The predictive ability of risk factors for PMV was assessed using an area under the receiver operating characteristic (ROC) curve.


RESULTS
Sixty-one patients required PMV after cardiac surgery. The median duration of MV was 150 h in PMV patients, while it was 28 h in non-PMV patients. The independent risk factors for PMV were risk adjustment for surgery for congenital heart disease (RACHS)-1 (p = 0.041), nosocomial pneumonia (p = 0.001), low cardiac output syndrome (LCOS) [p = 0.001], postoperative cumulative positive fluid balance (p = 0.032), and extubation failure (EF) [p = 0.027]. The value for the ROC curve was 0.940.


CONCLUSIONS
The present results strongly suggest that RACHS-1, nosocomial pneumonia, LCOS, fluid retention postoperatively, and EF are risk factors for PMV in neonates and young infants undergoing reparative surgery for congenital heart disease.
Shi
ShanShan
S
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Zhao
ZhengYan
Z
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Liu
XiWang
X
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Shu
Qiang
Q
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Tan
LinHua
L
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Lin
Ru
R
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Shi
Zhuo
Z
Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Fang
Xiangming
X
Department of Anesthesiology, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address: xiangming_fang@163.com.
D000367:Age Factors; D002315:Cardiopulmonary Bypass; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D015300:Ventilator Weaning