title: Extubation Failure in Neonates After Cardiac Surgery: Prevalence, Etiology, and Risk Factors.
abstract: BACKGROUND
  The purpose of this study was to explore the prevalence, etiology, and risk factors of extubation failure (EF) in post-cardiac surgery neonates.
  
  
  METHODS
  Neonates (30 days old or younger) who underwent cardiac surgery and were admitted to the cardiac intensive care unit between September 2010 and February 2016 were included. The prevalence and etiology of EF, defined as reintubation within 48 hours, were reviewed. Demographic, operative, and perioperative data were retrospectively collected. Multiple logistic regression models were constructed to identify the risk factors for EF.
  
  
  RESULTS
  The median age at surgery was 10 days. Extubation failure occurred in 25 of 156 cases (16.0%; 95% confidence interval: 10.6% to 22.7%), because of respiratory dysfunction (n = 16), hemodynamic instability (n = 4), upper airway obstruction (n = 4), or gastrointestinal bleeding (n = 1). Subsequent extubations were successful in 17 cases (68%) because of medical optimization of the causes of reintubation. The remaining 8 cases needed surgical reintervention, including tracheostomy and cardiac surgery. The inhospital mortality rate was 2.6%. In a bivariate analysis, younger age, airway diseases, ventilation before surgery, prolonged mechanical ventilation, and delayed sternal closure were associated with EF. The multivariable analysis identified airway diseases (adjusted odds ratio 18.2, 95% confidence interval: 3.8 to 88.6, p = 0.0003) and mechanical ventilation longer than 7 days (adjusted odds ratio 8.2, 95% confidence interval: 1.9 to 34.9, p = 0.0046) as risk factors for EF.
  
  
  CONCLUSIONS
  The prevalence of EF is relatively high in neonatal cardiac surgery. The etiologies can be diverse. Extubation of neonates at high risk after cardiac surgery, based on these possible risk factors, requires more diligent approaches.
authors.affiliation: Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan. Electronic address: shin.nya1982@gmail.com.
authors.forename: Shinya
authors.initials: S
authors.lastname: Miura
authors.affiliation: Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Nao
authors.initials: N
authors.lastname: Hamamoto
authors.affiliation: Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Osaki
authors.affiliation: Department of Cardiac Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakano
authors.affiliation: Department of Cardiology, Shizuoka Children's Hospital, Shizuoka, Japan; School of Mathematics and Statistics, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Chisato
authors.initials: C
authors.lastname: Miyakoshi
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors