Predictors of Successful Early Extubation Within 24 Hours Among Patients Undergoing Repair of Tetralogy of Fallot

Abstract

SESSION TITLE: Airway Management & Mechanical Ventilation SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Early extubation (<24 hours) in children undergoing surgery for congenital heart disease was associated with lower mortality. Certain preoperative and intraoperative factors were associated with early extubation. This study aimed to determine the variables that could predict a successful early extubation. METHODS: This was a retrospective study done at the Philippine Heart Center and included pediatric subjects who underwent repair of tetralogy of Fallot and were extubated within 24 hours postoperatively from October 2015 to February 2017. Demographics, clinical characteristics, preoperative, intraoperative and pre-extubation variables were gathered. The decision when to extubate was made by the attending physician in the surgical intensive care unit. Preoperative variables were: oxygen saturation, pulmonary artery (PA) size, pulmonic stenosis (PS) gradient; and presence of a respiratory tract infection within 2 weeks of the surgical procedure. Intraoperative data included times for cardiopulmonary bypass and cross-clamp. Pre-extubation variables included were arterial blood gas pH, pCO2, and pO2; duration of mechanical ventilation; duration of spontaneous ventilation; and white blood cell count and hematocrit. Radiologic findings such as atelectasis, pulmonary congestion/edema, pleural effusion, diaphragmatic paralysis and pneumothorax noted prior to extubation were recorded. Cardiorespiratory variables collected before and immediately after extubation included heart rate, respiratory rate and oxygen saturation. For the purpose of this study, successful early extubation was defined as extubation within the first 24 hours post-operatively and were not re-intubated within the next 48 hours. Those who were re-intubated within 48 hours of extubation belonged to the failure group. RESULTS: Eighty-four subjects (46 males, 38 females) were included in the study. Those who had failure of early extubation were males and were younger (mean age: 2.5 years old). There was no significant difference between the groups as to age, gender, weight, and presence of preexisting comorbidities. Among the pre-extubation variables, arterial pH and the presence of diaphragmatic paralysis showed significant difference. The arterial pH was lower at 7.3 (+0.03) in the failure group compared to 7.4 (+0.04) in the success group (p=0.012). Diaphragmatic paralysis was present in one patient (50%) in the failure group. For the post-extubation variables, the oxygen saturation was lower in the failure group, which was 93.5 (+ 2.1). This study showed that the rate of successful early extubation among patients who underwent TOF repair was high at 98%. The variables that showed significant difference for failed early extubation were lower arterial pH and the presence of diaphragmatic paralysis. CONCLUSIONS: This study demonstrated that successful early extubation in patients after TOF correction was high (98%). The lower arterial pH and the presence of diaphragmatic paralysis showed significant difference and predicted failed early extubation. The other variables did not show any significant difference between the success and failure group. CLINICAL IMPLICATIONS: This study can help determine the TOF patients who can be successfully extubated within 24 hours postoperatively. DISCLOSURE: The following authors have nothing to disclose: Ana Noelle Dominguez No Product/Research Disclosure Information