Objectives: To determine if indices of alveolar gas exchange preextubation predict postextubation respiratory support needs as well as the need for escalation of therapies following infant cardiac surgery.
Design: Retrospective chart review.
Setting: Pediatric cardiac ICU in a quaternary-care teaching hospital.
Patients: Infants less than 1 year old who underwent biventricular repair from January 2015 to December 2017.
Interventions: None.
Measurements and main results: Preextubation alveolar-arterial gradient, oxygenation index, oxygen saturation index, Pao2/Fio2 ratio, and dead space ventilation (analyzed with both end-tidal carbon dioxide gradient and dead space fraction) were evaluated for each patient. All but dead space ventilation were associated with a higher level of noninvasive respiratory support immediately postextubation. Furthermore, impaired preextubation gas exchange was independently associated with escalation of respiratory support within the first 48-hour postextubation.
Conclusions: Validated measures of alveolar gas exchange can be used as a tool to assess postextubation respiratory support needs including the risk of escalation of respiratory support in the first 48-hour postextubation. Prospective study with implementation of extubation guidelines, both for readiness and determination of early postextubation support, is needed to validate these findings.
Keywords: Pao2/Fio2 ratio; congenital heart surgery; extubation readiness; gas exchange; postoperative care; pulmonary function.
Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.