Risk Factors For Prolonged Mechanical Ventilation Research Articles

Construction of a nomogram risk prediction model for prolonged mechanical ventilation in patients following surgery for acute type A aortic dissection.

This study aims to analyze the risk factors associated with prolonged mechanical ventilation (PMV) in patients following surgical treatment for acute type A aortic dissection (ATAAD). The objectives include constructing a predictive model for risk assessment and validating its predictive efficacy. A total of 452 patients diagnosed with ATAAD and undergoing surgical procedures at a tertiary hospital in Nanjing between January 2021 and April 2023 were selected using a convenience sampling method. Patients were categorized into two groups: PMV group (n = 132) and non-PMV group (n = 320) based on the occurrence of prolonged mechanical ventilation (PMV), and their clinical data were compared. The data were randomly divided into a modeling set and a validation set in a 7:3 ratio. Risk factors for PMV were identified in the modeling group using logistic regression analysis. A risk prediction model was constructed using R 4.1.3 software, visualized via a column chart. Receiver Operating Characteristic (ROC) curves were generated using the validation set to assess model differentiation. Calibration curves were plotted to evaluate accuracy and consistency, and Decision Curve Analysis (DCA) was applied to evaluate clinical utility. The logistic regression analysis identified age, body mass index, preoperative white blood cell count, preoperative creatinine, preoperative cerebral hypoperfusion, and cardiopulmonary bypass time as significant risk factors for postoperative PMV in patients with ATAAD. The area under the curve (AUC) for the validation set ROC curve was 0.856, 95% confidence interval (0.805-0.907), indicating good discrimination. Calibration curves revealed strong alignment with the ideal curve, and the Hosmer-Lemeshow goodness-of-fit test indicated a well-fitted model (P = 0.892). The DCA curve demonstrated a high net benefit value, highlighting the model's strong clinical utility. The risk prediction model developed in this study for PMV in patients undergoing surgery for ATAAD exhibits robust predictive performance. It provides valuable insights for healthcare practitioners in predicting the likelihood of PMV and devising timely and personalized intervention strategies.

Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study

BackgroundA significant proportion of patients with severe chest trauma require mechanical ventilation (MV). Early prediction of the duration of MV may influence clinical decisions. We aimed to determine early risk factors for prolonged MV among adults suffering from severe blunt thoracic trauma. MethodsThis retrospective, single-center, cohort study included all patients admitted between January 2014 and December 2020 due to severe blunt chest trauma. The primary outcome was prolonged MV, defined as invasive MV lasting more than 14 days. Multivariable logistic regression was performed to identify independent risk factors for prolonged MV. ResultsThe final analysis included 378 patients. The median duration of MV was 9.7 (IQR 3.0–18.0) days. 221 (58.5 %) patients required MV for more than 7 days and 143 (37.8 %) for more than 14 days. Male gender (aOR 3.01, 95 % CI 1.63–5.58, p < 0.001), age (aOR 1.40, 95 % CI 1.21–1.63, p < 0.001, for each category above 30 years), presence of severe head trauma (aOR 3.77, 95 % CI 2.23–6.38, p < 0.001), and transfusion of >5 blood units on admission (aOR 2.85, 95 % CI 1.62–5.02, p < 0.001) were independently associated with prolonged MV. The number of fractured ribs and the extent of lung contusions were associated with MV for more than 7 days, but not for 14 days. In the subgroup of 134 patients without concomitant head trauma, age (aOR 1.63, 95 % CI 1.18–2.27, p = 0.004, for each category above 30 years), respiratory comorbidities (aOR 9.70, 95 % CI 1.49–63.01, p = 0.017), worse p/f ratio during the first 24 h (aOR 1.55, 95 % CI 1.15–2.09, p = 0.004), and transfusion of >5 blood units on admission (aOR 5.71 95 % CI 1.84–17.68, p = 0.003) were independently associated with MV for more than 14 days. ConclusionsSeveral predictors have been identified as independently associated with prolonged MV. Patients who meet these criteria are at high risk for prolonged MV and should be considered for interventions that could potentially shorten MV duration and reduce associated complications. Hemodynamically stable, healthy young patients suffering from severe thoracic trauma but no head injury, including those with extensive lung contusions and rib fractures, have a low risk of prolonged MV.

Risk Factors Associated With Prolonged Mechanical Ventilation and Length of Stay After Repair of Tetralogy of Fallot.

This study examined preoperative, intraoperative, and postoperative data to identify factors that are associated with prolonged mechanical ventilation (PMV) and prolonged intensive care unit length of stay (ICU LOS) in tetralogy of Fallot (TOF) patients undergoing repair surgery. A retrospective study was carried out after approval from the institutional review board. All patients (age 0-52 years) who underwent TOF repair from January 2016 to September 2022 were included. Prolonged mechanical ventilation was defined as >24 h of ventilation, while prolonged ICU LOS was defined as ICU stay >3 days. A total of 922 patients were included, among whom 288 (31.2%) were intubated for >24 h and 222 (24.1%) stayed in ICU for >3 days. Younger age (odds ratio [OR] = 2, 95% confidence interval [CI] 1.2-3.3, P = .007), lower weight (OR = 2.1, 95% CI 1.2-3.5, P = .003), and residual lesion (OR = 3.27, 95% CI 1.2-8.7, P = .017) were associated with PMV. Moreover, independent risk factors for prolonged ICU LOS are similar to PMV risk factors, including younger age (OR = 2.3, 95% CI 1.28-4.12, P = .005), lower weight (OR = 2.83, 95% CI 1.58-5, P < .001), underweight status (OR = 1.7, 95% CI 1.12-2.57, P = .012), and residual lesion (OR = 3.79, 95% CI 1.43-10.05, P = .007). Both aortic cross-clamp and cardiopulmonary bypass times did not exhibit clinically significant risk factors toward PMV and prolonged ICU LOS. The risk factors for PMV and prolonged ICU LOS were residual lesion, younger age, and lower weight. Nutritional status contributed to the risk of prolonged ICU LOS, but not PMV. Consideration of these factors may provide optimal care to improve the outcome following TOF corrective surgery.

Analysis of risk factors of prolonged mechanical ventilation in patients with severe burn injury.

Mechanical ventilation is an essential means of life support for patients with severe burns. However, prolonged mechanical ventilation (PMV) increases the incidence of complications and length of hospital stay. Therefore, studying the risk factors of mechanical ventilation duration is of great significance for reducing the duration of mechanical ventilation, reducing related complications, and improving the success rate of severe burn treatment. This study was a retrospective study of patients with burns ≥30% of the area admitted to the BICU of Guangzhou Red Cross Hospital affiliated with Jinan University from January 2016 to January 2023 who were mechanically ventilated. Patients were classified into the prolonged mechanical ventilation group if they were mechanically ventilated for ≥21 days. Then, independent risk factors for prolonged mechanical ventilation were determined by logistic regression analysis of the collected data. Of all the 112 enrolled patients, 79 had prolonged mechanical ventilation, with an incidence of 70.5%. Logistic regression analysis revealed that including abbreviated burn severity index (ABSI%) (P < 0.001), moderate and severe inhalation injury (P = 0.005, P = 0.044), albumin (P = 0.032), lactic acid (P < 0.001) were independent risk factors for prolonged mechanical ventilation. In addition, ventilator-related complications were 44% in the PMV group and 21% in the non-PMV group. ABSI%, inhalation injury, albumin, and lactic acid on admission are the risk factors for PMV in severe burn patients. In addition, ventilator-related complications were higher in group PMV than in group non-PMV in our study.

Risk factors for prolonged mechanical ventilation in neonates following gastrointestinal surgery.

BackgroundProlonged mechanical ventilation (MV) should be avoided in neonates. Noninvasive ventilation (NIV) can facilitate weaning from MV but has risks for patients immediately following foregut surgery due to the potential risk of anastomotic leak. We evaluated the risk factors for prolonged MV following intestinal surgery in neonates.MethodsWe retrospectively reviewed 253 neonates undergoing intestinal surgery in 2017-2018 to identify risk factors for prolonged MV, and determine the correlation between NIV and anastomotic leak in a tertiary neonatal intensive care unit that performs the greatest number of neonatal surgeries in Ontario.ResultsThe most common diagnoses were necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) 21%, intestinal atresia 16%, esophageal atresia/tracheoesophageal fistula 14%, ano-rectal malformation 13%, malrotation/volvulus 11%, gastroschisis 9% and omphalocele 4%. The median (IQR) duration of MV post-surgery was 3 (1–8) days with 25.7 % (n=65) of neonates on MV for >7 days. Compared to infants on MV post-surgery for ≤7 days, those with MV>7 days were of lower gestational age, birth weight and weight at surgery, but a higher proportion underwent stoma creation, had a longer duration of opioid administration and higher rates of moderate to severe bronchopulmonary dysplasia (BPD) and mortality (P<0.05). Generalized linear regression analysis showed lower gestational age (GA) and longer opioid administration were associated with longer duration of MV (P<0.001), but indication for surgery, weight at surgery and stoma creation didn’t correlate with longer duration of MV (P>0.05). Of the 122 patients handled by one-stage resection with primary anastomosis, 22.1% (n=27) received NIV with 74.1% (n=20) commenced on NIV after 7 days post-surgery, anastomotic leak was detected in 2.5 % (3/122) patients and didn’t correlate with NIV.ConclusionsLower GA and longer opioid administration were risk factors for prolonged MV in neonates following intestinal surgery. Further research is needed to investigate modifiable practices around pain assessment/ventilation in these patients, and the correlation between NIV and anastomotic leak.

Risk factors for prolonged mechanical ventilation after congenital heart surgery in pediatric patients

Introduction. Prolonged mechanical ventilation (PMV) is a well-recognized factor as a quality metric for pediatric cardiac surgical programs. Most of the risk factors for PMV are described and analyzed. Some authors had established predictive models to detect proactively patients in risk for PMV. This study aims to develop a new predictive model, based on vasoactive-ventilation-renal (VVR) score, for PMV after congenital heart surgery (CHS) in pediatric patients. Material and Methods. Medical &amp;#64257; les of patients 0-18 y who underwent heart surgery in 2016 and 2017 were reviewed. Patients that met the inclusion criteria were studied. PMV was de&amp;#64257; ned as invasive mechanical ventilation &amp;ge; 96 h. The patients were divided in two groups according to duration of mechanical ventilation: group 1-patients with PMV, group 2-patients without PMV. The focus was set on VVR score and &amp;#64258; uid overload in the &amp;#64257; rst 48 hours after the operation. Data were presented as medians with IQR or as means &amp;plusmn; standard deviation. A non-parametric Mann-Whitney U test, binary logistic regression test and ROC&amp;nbsp;curve analysis integrated in the statistical software SPSS 24.0 were used. A value of P &lt; 0.05 was considered signi&amp;#64257; cant. Results. 438 patients were operated in 2016 and 2017 and 384 of them were included in the study. 80 patients (20.8%) needed PMV (group 1) and 304 (79.2%) did not need PMV (group 2). There was a statistical signi&amp;#64257; cance between group 1 and group 2 concerning the peak VVR for the day of operation 58,25(33,48) vs. 25,65(19,8) and cumulative &amp;#64258; uid overload in % for the &amp;#64257; rst 48hours +2,54(13,29) vs. &amp;ndash; 1,19(3,4). After combining this two factors in a predictive model, the ROC curve analysis showed AUC 0,903 (95% CI 0,863-0,944) with sensitivity of 86.25% and speci&amp;#64257; city of 82,57%. Conclusion. Combining VVR and cumulative &amp;#64258; uid overload, resulted in establishment of a new reliable predictive model for PMV after CHS in pediatric patients in our Center.

Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment

BackgroundThis study aimed to identify risk factors for prolonged mechanical ventilation (PMV) and its association with disease prognosis following acute DeBakey type I aortic dissection surgery.MethodsA total of 582 patients who received emergency surgery for acute DeBakey type I aortic dissection from 2014 to 2018 were enrolled in this study. Mechanical ventilation period after surgery longer than 48 hours was defined as postoperative PMV. Multiple logistic regression analysis was used to identify risk factors for PMV. This study also compared short- and long-term outcomes in patients who developed PMV with patients who did not develop this complication. To identify and compare long-term cumulative survival rate, Kaplan-Meier survival curve was plotted.ResultsAmong all enrolled patients, 259 (44.5%) received PMV treatment. Our data suggested that the length of intensive care unit and hospital stay were longer for patients who received PMV treatment. Thirty-day mortality was also higher in patients with PMV than in patients without PMV. Elevated leukocyte count and increased serum cystatin C level upon admission, lower preoperative platelet count and longer cardiopulmonary bypass (CPB) duration were identified as risk factors for PMV. Interestingly, our data suggested that there was no significant difference of survival rate between patients with or without PMV history.ConclusionsPMV after DeBakey type I aortic dissection repair surgery was a common complication and associated with increased short-term mortality rate but did not affect long-term mortality rate. Elevated preoperative leukocyte count, increased preoperative serum cystatin C level, lower preoperative platelet count and longer CPB duration were risk factors for PMV.

Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China

BackgroundMaternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.MethodsThe clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. PMV was defined as a mechanical ventilation length of more than 24 h. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.ResultsOut of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 h. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO2/FiO2 (OR=0.989, P< 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.ConclusionsEstimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

Positive cumulative fluid balance in the first 72 h is associated with adverse outcomes following heat stroke

Objective: The objective of the study was to determine the association between positive cumulative fluid balance following heat stroke (HS) and its impact on patient outcomes.Methods: A retrospective chart review of HS patients admitted to the emergent intensive care unit (ICU), Beijing Lu He Hospital, Capital Medical University, from 2015 to 2018 was conducted.Results: Forty-nine surviving HS patients met the inclusion criteria. Patients were divided into two groups based on the median duration of mechanical ventilation (MV). Patients with MV for more than 6 days were placed in the longer length of the MV group. Patients with MV for <6 days were placed in the shorter MV group. There were significant differences between the two groups regarding the fluid balance on day 2 (3040 ml vs. −533 ml, P = 0.017) and persistent cumulative fluid overload in the first 72 h (6112 ml vs. −46 ml, P = 0.04). Patients with a higher cumulative fluid overload in the first 72 h were more likely to receive a longer duration of MV (10.7 days vs. 3.2 days, P < 0.001) and ICU length of stay (22.5 days vs. 6.2 days, P < 0.001). Spearman analysis of fluid overload in the first 72 h and MV time showed that the correlation coefficient was 0.662. Binary logistic regression analysis showed that the positive cumulative fluid balance in the first 72 h (odds ratio [OR] = 1, 95% confidence interval [95% CI] = 0.99–1.01] and alanine aminotransferase (OR = 0.978, 95% CI = 0.95–0.99) were both independent risk factors for prolonged MV in patients with HS (P = 0.025, P = 0.026). There were also differences between groups regarding creatine kinase-MB (P = 0.01) and Glasgow Coma Scale scores (P = 0.033). The patients with a higher cumulative fluid overload in the first 72 h had larger sequential organ failure assessment cores. Based on the receiver operating characteristic analysis, the cumulative fluid overload in the first 72 h predicted the need for invasive MV with the area under the curve of 0.869 (P < 0.0001, 95% CI: 0.779–0.958) at a cutoff value >1685 ml (sensitivity: 86%; specificity: 78%).Conclusions: Fluid overload in the first 72 h was a predictor of prolonged MV and ICU length of stay in surviving HS patients. Maintaining cautious about fluid resuscitation for HS patients may be critical for improving patient outcomes.

Risk factors for prolonged mechanical ventilation after surgical repair of congenital heart disease. Experience from a single cardiac center.

Objectives:We studied these predictors at a single cardiac center.Methods:A retrospective cohort study was carried out after obtaining approval from the institutional review board. All patients (age, 0-14 years) who underwent congenital heart disease (CHD) surgery from January 2014 to June 2016 were included. Prolonged mechanical ventilation (PMV) was defined as >72 hours of ventilation.Results:A total of 257 patients were included, among whom 219 (85.2%) were intubated for >72 hours and 38 (14.8%) were intubated for ≥72 hours. Age (29.9 versus 11.95 years), weight (9.6 versus 5.9 kg), cross-clamp time (CCT) (53.6 versus 71.8 min), cardiopulmonary bypass time (CBP) (80.98 versus 124.36 min), length of stay in the pediatric intensive care unit (PICU) (10.4 versus 27.2 days), infection (12.8% versus 42.1%), open sternum (0.9% versus 13.2%), re-intubation (19.2% versus 39.5%), pulmonary hypertension (10.9% versus 31.6%), and impaired heart function (10.1% versus 23.7%) were associated with PMV. In terms of Risk Adjustment in Congenital Heart Surgery (RACHS) classification, only patients with RACHS 4 (18.4%) were associated with the risk for PMV.Conclusions:Age, weight, CBP, CCT, pulmonary hypertension, impaired cardiac function, and sepsis are risk factors for PMV. These factors should be considered when deciding surgery and in providing PICU care.

Hypochloremia, blood transfusion, and neuromuscular drug use can be associated with prolonged mechanical ventilation in pediatric intensive care

Background: Mechanical ventilation (MV) is one of the most important components of modern intensive care practice. Longer MV time is associated with increased morbidity and mortality. Therefore, it is important to identify the risk factors associated with longer duration of MV. The objective of this study was to determine the clinical and the laboratory risk factors for prolonged invasive MV in the pediatric intensive care unit (PICU). Methods: We performed a retrospective analysis of the records of all patients admitted to our PICU between October 2016 and March 2018. Patients with invasive MV were included in the study. Results: A total of 121 children with a mean age of 3.58 ± 4.84 years were enrolled in this study. The most frequent diagnosis at the time of admission to the PICU was primary respiratory disease (31.4%), followed by neurological diseases (22.3%), and sepsis (17.4%). Pressure control was the most commonly used MV method in 97 (80.2%) patients. Pressure regulated volume control was used in the other (19.8%) patients. The mean duration of mechanical ventilation was 9.17 ± 8.12 days. Risk factors for prolonged MV in the PICU included red blood cell (RBC) transfusion, hypochloremia, high gamma-glutamyl transferase (GGT), and low body mass index (BMI). The logistic regression analysis showed that hypochloremia prolonged MV by 3.234 fold, neuromuscular blocker drug uses prolonged MV by 3.689 fold, and RBC transfusion prolonged MV by 8.031 fold. Conclusion: Hypochloremia, need for RBC transfusion, and neuromuscular blocker drug use may be early predictors of prolonged MV in critically ill children.

Acute Kidney Injury on Ventilator Initiation Day Independently Predicts Prolonged Mechanical Ventilation in Intensive Care Unit Patients

Purpose: The purpose of this study is to identify the predictors for prolonged mechanical ventilation (PMV) of more than 21 days among intensive care unit (ICU) patients. Material and Methods: A retrospective observational study was conducted in a respiratory ICU from December 2008 to November 2009. The outcome measurement was the occurrence of PMV. Acute kidney injury (AKI) was identified and defined as an increase in the serum creatinine level of 50% or greater from baseline. Results: Of154patientsenrolled,41patients(26.6%)hadPMV.PatientswithPMVshowedhigherAcute Physiology and Chronic Health Evaluation II scores, lower serum albumin levels, and more AKI on mechanicalventilation(MV)initiationdaycomparedwiththenon-PMVpatients.PatientswithPMVwere significantly associated with longer MV duration before the day of readiness for weaning (DRW) and a higher rapid shallow breathing index on DRW. In a multivariate regression analysis, the independent risk factors for PMV were AKI on MV initiation day (odds ratio [OR], 5.630; 95% confidence interval [CI], 1.378-22.994; P = .016), longer MV duration before DRW (OR, 1.289; 95% CI, 1.158-1.435; P b .001), and higher rapid shallow breathing index on DRW (OR, 1.012; 95% CI, 1.003-1.021; P = .010). Conclusions:AcutekidneyinjuryonMVinitiationdayisanindependentriskfactorforPMVofmorethan 21 days, which may be helpful for clinicians to refine their management of these ICU patients early.

Presurgical Risk Factors for Late Extubation in Medicare Recipients After Cardiac Surgery

Medicare recipients, particularly those 80 years of age and older, are increasingly undergoing coronary artery bypass grafting surgery (CABGS). There is an association between older age and need for prolonged mechanical ventilation (MV); however, it is unclear what other presurgical characteristics may contribute to prolonged time on the ventilator in older adults. To develop and validate a probability model for prolonged MV utilizing selected presurgical patient characteristics. A retrospective, nonexperimental design was utilized to study 548 Medicare recipients (65 years of age or older) undergoing CABGS during 1998. Data were obtained from an existing coronary artery surgery clinical database. RESULTS Based on extubation time, the sample was comprised of two groups (Group 1, N = 205; MV <or= 5 hours. Group 2, N = 343; MV > 5 hours). Using logistic regression modeling, predictors of late extubation included: (a). age of 80 years or older (odds ratio [OR] 2.99, p =.003), (b). female sex (OR = 1.76, p =.011), (c). hypertension (OR = 1.60, p =.018), (d). urgent or emergent preoperative clinical status (OR = 3.04, p =.002), and (e). prior CABGS (OR = 2.14, p =.009). The predictive model provided moderate discrimination of time to extubation group (concordance statistic = 0.656). Older age, urgent or emergent preoperative clinical status, and prior CABGS are risk factors for prolonged MV, which have been consistently identified in combined adult and older adult samples. Female sex and hypertension have not been well supported in earlier studies as risk factors for prolonged MV. The exploratory model provides a preliminary indication of factors placing Medicare recipients at risk for late extubation, but requires further development and testing for use by nurses in clinical practice.

Prolonged Mechanical Ventilation after Cardiac Surgery in Young Children: Incidence, Etiology, and Risk Factors

Children undergoing congenital heart surgery require postoperative mechanical ventilation. Despite recent advances, prolonged mechanical ventilation (PMV) is necessary in some patients and may increase the risk of post-operative complications. The purpose of this study was to identify incidence and risk factors for PMV. The authors performed a retrospective chart review. They defined PMV as ventilation longer than 48 hours. Mixed-effects linear regression models were used to assess the relationship between each factor and duration of mechanical ventilation. Separate models were developed for preoperative, intraoperative, and postoperative periods. To determine the extent to which a combination of risk factors would predict PMV, the most significant variables were adopted to fit a model using number of risk factors to predict PMV. Two hundred twelve children ≤ 36 months were included. Eleven (5.2%) children died perioperatively. Of the patients, 72.6% (143/197) were extubated by 48 hours. Age &lt; 6 months, perioperative infection, inotrope use &gt; 48 hours, total parenteral nutrition use, and failed extubation were associated with PMV. PMV occurred in 28% of the patients in this study. The presence of 2 risk factors predicted PMV with a sensitivity of 86% and a specificity of 94%.

192 PROLONGED MECHANICAL VENTILATION OF INFANTS AFTER OPEN HEART SURGERY

Records of all 140 infants <2 years undergoing open heart surgery 7/80–9/84 were studied to evaluate the relationship between duration of mechanical ventilation (MV) and mortality, and risk factors for prolonged MV. MV was required for: 0–1 day (84), 2–6 days (37), >7 days (19). The 16% mortality in those with MV ≥7 days did not exceed that in infants with briefer MV (17%). Factors which prolong MV include: younger age (p<.005) (mean 10 mo), longer bypass time (p<.005) (mean 105 min), longer aortic cross clamp time (p<.01) (mean 51 min), and pre-op MV (p<.05). A predictive index (PI) for each patient was derived by assigning a +1 score for each factor when its value was worse than the mean. PI ≥2 predicted prolonged MV ≥7 days with 95% sensitivity and 57% specificity. MV ≥7 days occurred in 26% of infants with PI ≥2 and only in 1% with PI <2. Post-op factors including premature extubation requiring reintubation (p<.005) and requirement for a second surgical procedure (p<.005) also lengthened MV. The R2=.57 for combined significant variables in relation to duration of MV. While not predictive for the entire population, among the 19 requiring MV ≥7 days, 14 had pre-op elevation of pulmonary artery pressure, resistance, or blood flow, or high left atrial pressure. For patients predicted to have high risk of prolonged MV, early nutritional support, heightened vigilance for treatable complications and nosocomial infections, and avoidance of futile premature extubation are all suggested.