Publication Date
10-1-2022
Journal
Critical Care Explorations
DOI
10.1097/CCE.0000000000000782
PMID
36311558
PMCID
PMC9605742
PubMedCentral® Posted Date
10-25-2022
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
extubation failure, Norwood, parallel circulation, post-extubation respiratory support, single ventricle
Abstract
UNLABELLED: This study aims to determine whether bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) effectively mitigate the risk of extubation failure in children status post-Norwood procedure.
DESIGN: Single-center, retrospective analysis. Extubation events were collected from January 2015 to July 2021. Extubation failure was defined as the need for reintubation within 48 hours of extubation. Demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.
SETTING: Pediatric cardiovascular ICU.
PATIENTS: Neonates following Norwood procedure.
INTERVENTIONS: Extubation following the Norwood procedure.
MEASUREMENTS AND MAIN RESULTS: The analysis included 311 extubations. Extubation failure occurred in 31 (10%) extubation attempts within the first 48 hours. On univariate analysis, higher rate of extubation failure was observed when patients were extubated to CPAP/BiPAP relative to patients who were extubated to either high-flow nasal cannula (HFNC) or nasal cannula (NC) (16% vs 7.8%;
CONCLUSIONS: Clinicians should not rely on CPAP or BiPAP as the only supportive measure for a patient at increased risk of extubation failure. CPAP or BiPAP do not mitigate the risk of extubation failure in the Norwood patients. A multisite study is needed to generalize these conclusions.