Extubation failure after cardiac surgery in children with Down syndrome

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dc.contributor.authorSalgado, Fernanda
dc.contributor.authorLarios, Guillermo
dc.contributor.authorValenzuela, Gonzalo
dc.contributor.authorAmstein, Rodolfo
dc.contributor.authorValle, Patricio
dc.contributor.authorValderrama, Paulo
dc.date.accessioned2025-01-20T20:14:31Z
dc.date.available2025-01-20T20:14:31Z
dc.date.issued2023
dc.description.abstractExtubation failure (EF) after cardiac surgery is associated with poorer outcomes. Approximately 50% of children with Down syndrome (DS) have congenital heart disease. Our primary aim was to describe the frequency of EF and identify risk factors for its occurrence in a population of patients with DS after cardiac surgery. Secondary aims were to describe complications, length of hospital stay, and mortality rates. This report was a retrospective case-control study and was carried out in a national reference congenital heart disease repair center of Chile. This study includes all infants 0-12 months old with DS who were admitted to pediatric intensive care unit after cardiac surgery between January 2010 and November 2020. Patients with EF (cases) were matched 1:1 with children who did not fail their extubation (controls) using the following criteria: age at surgery, sex, and type of congenital heart disease. Overall, 27/226 (11.3%) failed their first extubation. In the first analysis, before matching of cases and controls was made, we found association between EF and younger age (3.8 months vs 5 months; p = 0.003) and presence of coarctation of the aorta (p = 0.005). In the case-control univariate analysis, we found association between an increased cardiothoracic ratio (CTR) (p = 0.03; OR 5 (95% CI 1.6-16.7) for a CTR > 0.59) and marked hypotonia (27% vs 0%; p = 0.01) with the risk of EF. No differences were found in ventilatory management.Conclusions: In pediatric patients with DS, EF after cardiac surgery is associated with younger age, presence of aortic coarctation, higher CTR reflecting the degree of cardiomegaly and hypotonia. Recognition of these factors may be helpful when planning extubation for these patients.
dc.fuente.origenWOS
dc.identifier.doi10.1007/s00431-023-04946-w
dc.identifier.eissn1432-1076
dc.identifier.issn0340-6199
dc.identifier.urihttps://doi.org/10.1007/s00431-023-04946-w
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/92202
dc.identifier.wosidWOS:000978695700002
dc.issue.numero7
dc.language.isoen
dc.pagina.final3164
dc.pagina.inicio3157
dc.revistaEuropean journal of pediatrics
dc.rightsacceso restringido
dc.subjectDown syndrome
dc.subjectExtubation failure
dc.subjectCongenital heart disease
dc.subjectCardiac surgery
dc.subjectCardiothoracic ratio
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleExtubation failure after cardiac surgery in children with Down syndrome
dc.typeartículo
dc.volumen182
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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