Perioperative factors associated with prolonged mechanical ventilation after complex congenital heart surgery

OBJECTIVE:: To evaluate perioperative factors associated with prolonged mechanical ventilation in children undergoing complex cardiac surgery for congenital heart disease. DESIGN:: Retrospective chart review. SETTING:: A tertiary care pediatric cardiac intensive care. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: This retrospective cohort study included all patients undergoing complex cardiac surgical procedures (Risk Adjustment in Congenital Heart Surgery-1 category ≥3) at our institution during 2003. We defined prolonged mechanical ventilation as need for mechanical ventilation for ≥7 days (90th percentile of duration of mechanical ventilation for the whole cohort). Multivariate logistic regression analyses were used to determine independent relationships between perioperative factors and prolonged mechanical ventilation. A total of 362 patients were admitted to the cardiac intensive care unit after a cardiac surgical procedure of Risk Adjustment in Congenital Heart Surgery-1 ≥3 level of complexity and survived to hospital discharge. Median age was 242 days (range, 4 days-14.4 yrs), the median duration of mechanical ventilation was 1.5 days (range, 0-7 days), and 41 patients (11%) were ventilated for ≥7 days. Age of <30 days at surgery, higher Pediatric Risk of Mortality III score at the time of cardiac intensive care unit admission, the presence of major noncardiac structural anomalies, healthcare-associated infections, noninfectious pulmonary complications (pleural effusions and pneumothorax), and the need for reintervention were all independently associated with prolonged mechanical ventilation. CONCLUSIONS:: Younger age, greater severity of illness at postoperative admission, healthcare-associated infections, noninfectious pulmonary complications, and the need for reintervention are associated with prolonged mechanical ventilation after complex cardiac surgery. Future studies and quality improvement initiatives should focus on those risk factors that are modifiable to promote early extubation in children recovering from complex congenital heart surgery.