Journal of the Saudi Heart Association (Oct 2015)
30. Predictors for prolonged mechanical ventilation in children undergoing cardiac surgery
Abstract
Prolonged mechanical ventilation (PMV) has been associated with deleterious clinical outcomes. Characteristics of the patient and various peri-operative factors can predispose individuals to PMV leading to prolonged hospitalization, increasing costs, morbidity and mortality. We investigated specific predictors of PMV in children who underwent cardiac surgery in a tertiary care centre in Riyadh, Saudi Arabia. Method: Retrospective analysis of 413 pediatric cardiac surgeries performed during a 12 months period. Cases were divided in group-A (MV > 7 days) and group- B (MV < 7 days). Patient demographics, pre-operative, intra-operative and post-cardiac surgery variables including complications were reviewed. Continuous and Categorical variables were compared using Student’s t-test and Chi-square. Univariate and multivariate analyses were performed to identify predictors of PMV. Results: In total, 47 (11.4%) of the 413 children had PMV post-cardiac surgery. Group-A patients were younger [mean age: 7.6 months (SD 17.1) vs 23.4 months (SD 29.3), p < 0.0001], and lighter [mean weight: 4.5 kg (SD 3.7) vs 9.4 kg (SD 6.5), p < 0.0001] than Group-B. The mean duration of mechanical ventilation in Group-A was 21.6 days (SD 16.2) compared to 1.8 days (SD 1.5) in Group-B (p < 0.0001). On univariate analyses, significant predictors of PMV included younger age, low body weight, higher surgical risk category, delayed sternal closure, prolonged bypass and cross-clamp times, higher frequency of acute kidney injury, presence of surgical wound and blood stream infections, pneumonia, and UTI [p < 0.0001 for all analyses]. On multivariate analysis, younger age, low body weight, and higher surgical risk category and delayed sternal closure were significant for PMV. Conclusion: Post-operative infections and delayed sternal closure proved to be the most important factors determining the duration of ventilation. Aggressive efforts to ameliorate infection would facilitate successful early extubation after surgery.