Postextubation stridor in neonates and children undergoing cardiac surgery: two year of institutional experience

Abstract

Introduction. To describe risk factors associated with respiratory distress after extubation in the pediatric cardiac intensive care unit. Methods. A retrospective observational study was performed involving patients (n1⁄4514) undergoing pediatric cardiac surgery at a single university hospital from January 1, 2011 to December 31, 2012, excluding deaths. The patients were under 8 years of age. The study approved by the local Institutional Review Board. Clinical characteristics, surgical data, and intensive care unit outcome were obtained from medical records. Extubation criteria mainly were based on the clinical judgement of the surgeon, anesthesiologist and pediatric cardiolog. Extubation criteria included neurologic status to ensure airway protection, hemodynamic statu with minimal inotropic support (dopamine r 5 m/kg/min, no milrinone, no adrenaline), minimal ventilator setting (FiO2 o 0.5, peak inspiratory pressure r25 cmH2O) and appropriate arterial blood gases. Continous variables compared using Mann-Whitney U tests and categorical variables were compared using One-way Anova and chi-square when appropriate. Logistic regression models were used to determine variables impacting respiratory distress after extubation. Results. The patients were categorized into two groups according to postoperative stridor: Group PES (n1⁄4104) and group non-PES (n1⁄4410). Median age in group PES was smaller than group nonPES (9.5 14.5 months and 20.38 21.82 months, respectively, po0.005) and weight in group PES was less than group non-PES (5.7 3.5 kg and 8.9 5.6 kg, respectively, po0.005)]. Compared to preoperative intubation (24% and 4.4%, respectively, po0.005), with sydrome (22.1% and 10.2%, respectively, po0.005) and required cardiopulmonary bypass (67.1% and 32.9%, respectively, po0.009) were significantly higher in group PES. Multivariate logistic regression revealed that age (95% CI 0.971.03, p40.38) is not predictor of PES, however weight (95% CI 0.76-0.98, Po0.03), with syndrome (95% CI 1.46-4.89, po0.01), preoperative intubation (95% CI 2.18-9.12, po0.005) and required cardiopulmonary bypass (95% CI 1.16-3.76, po0.014) predictors of PES. Discussion. Our study resulted that post-operative post-extubation stridor is observed more frequently on new born and children who were undergone cardiopulmoner by pass and having syndrome associated with preoperative endotracheal intubation history. This study also proves that body weight has a more important effect on post-extubation stridor than age contrary to popular belief.