712: RISK FACTORS FOR POST-EXTUBATION STRIDOR IN CONGENITAL HEART SURGICAL PATIENTS

Abstract

Introduction: Post extubation stridor (PES) is a serious complication in children requiring mechanical ventilation. The goal of this study was to identify risk factors associated with PES in children undergoing corrective surgery for congenital heart disease (CHD), and to examine the association of PES with clinical outcomes. Methods: A retrospective analysis of children undergoing corrective surgery for CHD in 2021 was performed. Patients were excluded if they did not have complete data recorded in the medical record. Univariate analyses were performed using a Mann-Whitney U Test or Fisher’s Exact Test where appropriate. Logistic regression was used to conduct a multivariate analysis. Patients noted to have stridor at the time of extubation and those who received racemic epinephrine within 24 hours of extubation were considered to have developed PES. Results: Of 91 patients (mean 6.6 months, range 0.07-97.6 months; 51% male), 15 (16.4%) developed PES. Variables associated with the development of PES included requiring cardiopulmonary bypass (p=0.011), requiring aortic cross clamping (p=0.040), requiring circulatory arrest or regional perfusion (p=0.003), and requiring total body cooling (p=0.003). However, multivariate analysis including these variables did not yield any statistically significant associations. Age (p=0.203), BMI (p=0.234), length of mechanical ventilation (p=0.579), and use of an endotracheal tube larger than predicted (p=0.596) were not found to be significant risk factors for developing PES. Patients who developed PES were more likely to require reintubation (p< 0.001), require an ENT consult (p< 0.001), develop unilateral vocal fold paralysis (p< 0.048), require an ENT surgical intervention (p< 0.001), and require CPAP after extubation (p< 0.001). Developing PES was not associated with longer PICU and hospital length of stay (p=0.350, 0.105, respectively). Conclusions: Intra-operative variables associated with more complex surgeries are associated with the development of PES after CHD corrective surgery. The development of PES in this population was associated with important morbidities, including reintubation and ENT interventions. Further studies are required to identify modifiable variables to decrease this important clinical complication.