Descriptors of failed extubation in Norwood patients using physiologic data streaming

Authors

Fabio Savorgnan, Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Rohit S. Loomba, Advocate Aurora HealthFollow
Saul Flores, Department of Pediatrics, Section of Critical Care Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Craig G. Rusin, Department of Pediatrics, Section of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Feng Zheng, Department of Pediatrics, Section of Neonatology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Adel M. Hassan, Department of Pediatrics, Section of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Sebastian Acosta, Department of Pediatrics, Section of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA. sacosta@bcm.edu.Follow

Recommended Citation

Savorgnan F, Loomba RS, Flores S, et al. Descriptors of Failed Extubation in Norwood Patients Using Physiologic Data Streaming. Pediatr Cardiol. 2023;44(2):396-403. doi:10.1007/s00246-022-03084-8

Affiliations

The Heart Institute, Advocate Children's Hospital

Abstract

The objective of this study is to evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic profile of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure. This is a single-center, retrospective analysis. Extubation events were collected from January 2016 until July 2021. Extubation failure was defined as the need for re-intubation within 48 h of extubation. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations. The analysis included 311 extubations. The extubation failure rate was 10%. According to univariable analyses, failed extubations were preceded by higher respiratory rates (p = 0.029), lower end-tidal CO₂ (p = 0.009), lower pH (p = 0.043), lower serum bicarbonate (p = 0.030), and lower partial pressure of O₂ (p = 0.022). In the first 10 min after extubation, the failed events were characterized by lower arterial (p = 0.028) and cerebral NIRS (p = 0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 h post-extubation (p = 0.027). In multivariable analysis, vocal cord anomaly, cerebral NIRS at 10 min post-extubation, renal NIRS at pre-extubation and post-extubation, and end-tidal CO₂ at pre-extubation remained as significant co-variables. Oximetric indices before, in the 10 min immediately after, and 2 h after extubation and vocal cords paralysis are associated with failed extubation events in patients with parallel circulation.

Type

Article

PubMed ID

36562780