Risk factors for mechanical ventilation and reintubation after pediatric heart surgery.
OBJECTIVE
To determine the prevalence of and risk factors associated with the need for mechanical ventilation in children following cardiac surgery and the need for subsequent reintubation after the initial extubation attempt.


METHODS
Patients younger than 18 years who underwent cardiac operations for congenital heart disease at one of the participating pediatric intensive care units (ICUs) in the Virtual PICU Systems (VPS), LLC, database were included (2009-2014). Multivariable logistic regression models were fitted to identify factors likely associated with mechanical ventilation and reintubation.


RESULTS
A total of 27,398 patients from 62 centers were included. Of these, 6810 patients (25%) were extubated in the operating room (OR), whereas 20,588 patients (75%) arrived intubated in the ICU. Of the patients who were extubated in the OR, 395 patients (6%) required reintubation. In contrast, 2054 patients (10%) required reintubation among the patients arriving intubated postoperatively in the ICU. In adjusted models, patient characteristics, patients undergoing high-complexity operations, and patients undergoing operations in lower-volume centers were associated with higher likelihood for the need for postoperative mechanical ventilation and need for reintubation. Furthermore, the prevalence of mechanical ventilation and reintubation was lower among the centers with a dedicated cardiac ICU in propensity-matched analysis among centers with and without a dedicated cardiac ICU.


CONCLUSIONS
This multicenter study suggests that proportion of patients extubated in the OR after heart operation is low. These data further suggest that extubation in the OR can be done successfully with a low complication rate.
Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Ark. Electronic address: pgupta2@uams.edu.
Punkaj
P
Gupta
Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark.
Mallikarjuna
M
Rettiganti
Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark.
Jeffrey M
JM
Gossett
Division of Cardiology, Department of Pediatrics, Rady Children's Hospital, San Diego, Calif.
Justin C
JC
Yeh
Division of Pediatric Critical Care, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash; Virtual PICU Systems, LLC, Los Angeles, Calif.
Howard E
HE
Jeffries
Virtual PICU Systems, LLC, Los Angeles, Calif; Division of Critical Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wis.
Tom B
TB
Rice
Virtual PICU Systems, LLC, Los Angeles, Calif; Division of Critical Care Medicine, Department of Pediatrics and Anesthesiology, Children's Hospital Los Angeles, USC Keck School of Medicine, Los Angeles, Calif.
Randall C
RC
Wetzel
D000293:Adolescent; D000367:Age Factors; D060666:Airway Extubation; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D012121:Respiration, Artificial; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
center volume; mechanical ventilation; pediatric cardiac surgery; reintubation; surgical complexity