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This Article Full Text (PDF) All Versions of this Article: chest.07-2573v1 134/4/768    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Google Scholar Articles by Shi, S. Articles by Xiangming, F. PubMed PubMed Citation Articles by Shi, S. Articles by Xiangming, F.

Perioperative risk factors for prolonged mechanical ventilation following cardiac surgery in neonates and young infants*

^*From Children's hospital (Drs. S Shi, Zhao, Liu, Shu, Tan, Lin, Z Shi), Department of Anesthesiology (Dr. Fang), School of Medicine, Zhejiang University, Hangzhou, China

xiangming_fang{at}163.com

Abstract

Background Prolonged mechanical ventilation (PMV) after cardiac surgery in children is associated with a high postoperative morbidity and mortality, as well as increased ICU and hospital resource utilization. Little has been done to identify the predictors of PMV in neonates and young infants. This study was carried out to evaluate the perioperative risk factors for PMV in neonates and young infants undergoing cardiac surgery.

Methods Clinical records of 172 consecutive children aged 3-month were reviewed. PMV was defined as MV72 hrs following operation. After univariate analysis, a stepwise logistic regression analysis was used to evaluate the independent risk factors for PMV following cardiac surgery. The predictive ability of risk factors for PMV was assessed using area under receiver operating characteristic (ROC) curve.

Results Sixty-one patients required PMV after cardiac surgery. The median duration of MV was 150 hrs in PMV patients, while 28 hrs in non-PMV patients. The independent risk factors for PMV were risk adjustment for surgery for congenital heart disease (RACHS-1; P=0.041), nosocomial pneumonia (P=0.001), low cardiac output syndrome (P=0.001), postoperative cumulative positive fluid balance (P=0.032), and extubation failure (P=0.027). The value for ROC curve was 0.940.

Conclusions The present results strongly suggest that RACHS-1, nosocomial pneumonia, low cardiac output syndrome, fluid retention postoperatively and extubation failure are risk factors for PMV in neonates and young infants undergoing reparative surgery for congenital heart disease.

Key Words: Perioperative • risk factor • prolonged mechanical ventilation • cardiac surgery • neonate • young infant