Risk factors for mechanical ventilation and reintubation after pediatric heart surgery
Risk factors for mechanical ventilation and reintubation after pediatric heart surgery
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DOI：
10.1016/j.jtcvs.2015.09.080
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发表时间：
2016-02-01
影响因子：
6
通讯作者：
Wetzel, Randall C.
中科院分区：
文献类型：
--
作者：
Gupta, Punkaj;Rettiganti, Mallikarjuna;Wetzel, Randall C.
目的：确定儿童心脏手术后需要机械通气以及首次拔管后需要再次插管的患病率和相关风险因素。方法：在Virtual PICU Systems（VPS），LLC的参与儿科重症监护病房（ICU）之一接受先天性心脏病心脏手术的18岁以下患者，数据库（2009-2014年）。多变量logistic回归模型拟合，以确定可能与机械通气和再插管相关的因素。其中，6810例患者（25%）在手术室（OR）拔管，而20,588例患者（75%）在ICU插管。在OR中拔管的患者中，395例患者（6%）需要重新插管。相比之下，2054例患者（10%）需要再次插管的患者术后到达ICU。在调整后的模型中，患者特征、接受高复杂性手术的患者和在低容量中心接受手术的患者与术后机械通气和重新插管的可能性较高相关。此外，机械通气和再插管的患病率较低的中心与一个专门的心脏ICU的倾向匹配的分析中心之间，没有一个专门的心脏ICU.Conclusions：这项多中心研究表明，拔管的患者比例在OR心脏手术后是低的。这些数据进一步表明，手术室拔管可以成功完成，并发症发生率低。
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.