Incidence of Immediate Extubation After Pediatric Cardiac Surgery and Predictors for Reintubation

Objectives: The objectives were to assess the incidence of immediate tracheal extubation in the operating room after pediatric cardiac surgery and to investigate predictors for subsequent reintubation. Methods: This is a single institutional retrospective study including all patients who had a cardiac operation with cardiopulmonary bypass from 2011 to 2016. Patients who required preoperative ventilator support, postoperative open chest, or mechanical support were excluded. Predictors for reintubation after immediate extubation were analyzed only for patients with stage II palliation for single ventricle physiology. Results: Nine hundred nine qualifying operations were identified. Immediate extubation was performed in 590 (64.9%) operations. A multivariable logistic regression model showed that the identities of anesthesiologist (P=.0003), year of the operation performed (P <.001), cardiopulmonary bypass time (P <.001), and type of operations (P <.001) were significantly associated with immediate extubation. Reintubation was significantly less frequent in patients with immediate extubation compared to those without (6.1% vs 15.0%; P <.001). A subgroup analysis for stage II palliation showed that reintubation after immediate extubation was significant for younger age (0.42 vs 0.54 years, P=.044), lower Po2/ Fio2 and Po2 at the last blood gas analysis (66 vs 98 mm Hg, P=.032 and 39 vs 47 mm Hg, P=.008), and higher inotropic score (2 vs 0, P=.034). A multivariable logistic regression model showed that only inotropic score was significantly associated with reintubation (P=.018). Conclusions: Immediate extubation in the operating room after pediatric cardiac surgery can be performed in most patients. Inotropic score is a predictor for reintubation in stage II palliation.