CICU Instructor Baylor College of Medicine and Texas Children's Hospital Houston, Texas, United States
Abstract:
Objective: This study aims to determine whether bi-level positive airway pressure (Bi-PAP) and continuous positive airway pressure (CPAP) effectively mitigate the risk of extubation failure in children status-post Norwood procedure.
Design: This is a single-center, retrospective analysis of patients admitted to the CICU at Texas Children's Hospital following Norwood procedure. Extubation events were collected from January 2016 until July 2021. Extubation failure was defined as the need for re-intubation within 48 hours of extubation. Demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.
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/Bi-PAP relative to patients who were extubated to either high-flow nasal cannula (HFNC) or nasal canula (NC) (16% vs 7.8%, p=0.027). On multivariable analysis, the presence of vocal cord anomaly (odds ratio 3.08; p=0.005) and pre-extubation end-tidal CO2 (odds ratio 0.91; p=0.006) were simultaneously associated with extubation failure while also controlling for the post-extubation respiratory support (CPAP/Bi-PAP/HFNC vs. NC).
Conclusions: Clinicians should not rely on CPAP or Bi-PAP as the only supportive measure for a patient at increased risk of extubation failure. CPAP or Bi-PAP do not mitigate the risk of extubation failure in the Norwood patients.
