Descriptors of Failed Extubation in Norwood Patients Using Physiologic Data Streaming

• DOI: 10.1007/s00246-022-03084-8
• Publication Date: 2022-12-23T09:02:31Z
• Authors: Fabio Savorgnan; Rohit S. Loomba; Saul Flores; Craig G. Rusin; Feng Zheng; Adel M. Hassan; Sebastian Acosta
• Keywords: Advocate Pediatrics Faculty - Oak Lawn; Cardiology; Infant, Newborn; Carbon Dioxide; Parallel circulation; Pediatric and Adolescent Medicine; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Near-infrared spectroscopy; Norwood; Single ventricle; Hypoplastic Left Heart Syndrome; Airway Extubation; Humans; Advocate Pediatric Cardiology Faculty - Oak Lawn; Oximetry; Extubation failure; Oximetric monitoring; Retrospective Studies

Abstract Objective: To evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic profile of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure. Methods: Single-center, retrospective analysis. 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. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations.Results: The analysis included 311 extubations. The extubation failure rate was 10%. According to univariate analyses, failed extubations were preceded by higher respiratory rates (p=0.029), lower end-tidal CO2 (p=0.009), lower pH (p=0.043), lower serum bicarbonate (p=0.030), and lower partial pressure of O2 (p=0.022). In the first 10 minutes after extubation, the failed events were characterized by lower arterial (p=0.028) and cerebral NIRS (p=0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 hours post-extubation (p=0.027). In multivariate analysis, vocal cord anomaly, cerebral NIRS at 10 minutes post-extubation, renal NIRS at pre-extubation and post-extubation, and end-tidal CO2 at pre-extubation remained as significant co-variates.Conclusions: Oximetric indices before, in the 10 minutes immediately after, and 2 hours after extubation and vocal cords paralysis are associated with failed extubation events in patients with parallel circulation.