Impairment in Preextubation Alveolar Gas Exchange Is Associated With Postextubation Respiratory Support Needs in Infants After Cardiac Surgery

Impairment in Preextubation Alveolar Gas Exchange Is Associated With Postextubation Respiratory Support Needs in Infants After Cardiac Surgery

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OBJECTIVES:.To determine if indices of alveolar gas exchange preextubation predict postextubation respiratory support needs as well as E-Juice 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 Stair Basket 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.