title: Extubation Failure after Neonatal Cardiac Surgery: A Multicenter Analysis.
abstract: To describe the epidemiology of extubation failure and identify risk factors for its occurrence in a multicenter population of neonates undergoing surgery for congenital heart disease.
  
  
  
  We conducted a prospective observational study of neonates ≤30 days of age who underwent cardiac surgery at 7 centers within the US in 2015. Extubation failure was defined as reintubation within 72 hours of the first planned extubation. Risk factors were identified with the use of multivariable logistic regression analysis and reported as OR with 95% CIs. Multivariable logistic regression analysis was conducted to examine the relationship between extubation failure and worse clinical outcome, defined as hospital length of stay in the upper 25% or operative mortality.
  
  
  
  We enrolled 283 neonates, of whom 35 (12%) failed their first extubation at a median time of 7.5 hours (range 1-70 hours). In a multivariable model, use of uncuffed endotracheal tubes (OR 4.6; 95% CI 1.8-11.6) and open sternotomy of 4 days or more (OR 4.8; 95% CI 1.3-17.1) were associated independently with extubation failure. Accordingly, extubation failure was determined to be an independent risk factor for worse clinical outcome (OR 5.1; 95% CI 2-13).
  
  
  
  In this multicenter cohort of neonates who underwent surgery for congenital heart disease, extubation failure occurred in 12% of cases and was associated independently with worse clinical outcome. Use of uncuffed endotracheal tubes and prolonged open sternotomy were identified as independent and potentially modifiable risk factors for the occurrence of this precarious complication.
authors.affiliation: Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN. Electronic address: cmastrop@iupui.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Mastropietro
authors.affiliation: Division of Critical Care, Department of Pediatrics, Wayne State University School of Medicine, Children's Hospital of Michigan, Detroit, MI.
authors.forename: Katherine
authors.initials: K
authors.lastname: Cashen
authors.affiliation: Division of Cardiovascular Intensive Care, Phoenix Children's Hospital, Department of Child Health, University of Arizona, College of Medicine - Phoenix, Phoenix, AZ.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Grimaldi
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, Cleveland Clinic, Cleveland, OH.
authors.forename: Keshava Murty
authors.initials: KM
authors.lastname: Narayana Gowda
authors.affiliation: The Heart Center at Arnold Palmer Hospital for Children, Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, University of Central Florida College of Medicine, Orlando, FL.
authors.forename: Kurt D
authors.initials: KD
authors.lastname: Piggott
authors.affiliation: Division of Pediatric Cardiac Intensive Care, Department of Pediatrics, University of Wisconsin, Madison, WI.
authors.forename: Michael
authors.initials: M
authors.lastname: Wilhelm
authors.affiliation: Division of Critical Care at Phoenix Children's Hospital, Department of Child Health, University of Arizona, College of Medicine - Phoenix, Phoenix, AZ.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Gradidge
authors.affiliation: Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN.
authors.forename: Elizabeth A S
authors.initials: EAS
authors.lastname: Moser
authors.affiliation: Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Benneyworth
authors.affiliation: Divisions of Cardiology & Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: John M
authors.initials: JM
authors.lastname: Costello
mesh_terms: D060666:Airway Extubation / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D017211:Treatment Failure
keywords: CHD; airway extubation; congenital heart defects; hypoplastic left heart syndrome; neonatal intensive care; postoperative care