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Pulmonary Dead Space Fraction and Extubation Success in Children After Cardiac Surgery*

Devor, Renee, L., MD1,2; Kang, Paul, MPH3; Wellnitz, Chasity, RN, BSN, MPH4; Nigro, John, J., MD2,4; Velez, Daniel, A., MD2,4; Willis, Brigham, C., MD, MEd2,5

Pediatric Critical Care Medicine: April 2018 - Volume 19 - Issue 4 - p 301–309
doi: 10.1097/PCC.0000000000001456
Cardiac Intensive Care

Objectives: 1) Determine the correlation between pulmonary dead space fraction and extubation success in postoperative pediatric cardiac patients; and 2) document the natural history of pulmonary dead space fractions, dynamic compliance, and airway resistance during the first 72 hours postoperatively in postoperative pediatric cardiac patients.

Design: A retrospective chart review.

Setting: Cardiac ICU in a quaternary care free-standing children’s hospital.

Patients: Twenty-nine with balanced single ventricle physiology, 61 with two ventricle physiology.

Interventions: None.

Measurements and Main Results: We collected data for all pediatric patients undergoing congenital cardiac surgery over a 14-month period during the first 72 hours postoperatively as well as prior to extubation. Overall, patients with successful extubations had lower preextubation dead space fractions and shorter lengths of stay. Single ventricle patients had higher initial postoperative and preextubation dead space fractions. Two-ventricle physiology patients had higher extubation failure rates if the preextubation dead space fraction was greater than 0.5, whereas single ventricle patients had similar extubation failure rates whether preextubation dead space fractions were less than or equal to 0.5 or greater than 0.5. Additionally, increasing initial dead space fraction values predicted prolonged mechanical ventilation times. Airway resistance and dynamic compliance were similar between those with successful extubations and those who failed.

Conclusions: Initial postoperative dead space fraction correlates with the length of mechanical ventilation in two ventricle patients but not in single ventricle patients. Lower preextubation dead space fractions are a strong predictor of successful extubation in two ventricle patients after cardiac surgery, but may not be as useful in single ventricle patients.

1Division of Critical Care, Phoenix Children's Hospital, Phoenix, AZ.

2Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

3Department of Epidemiology and Biostatistics, University of Arizona College of Medicine-Phoenix, Phoenix, AZ.

4Division of Cardiovascular Surgery, Phoenix Children's Hospital, Phoenix, AZ.

5Division of Cardiovascular Intensive Care, Phoenix Children's Hospital, Phoenix, AZ.

*See also p. 377.

Presented, in part, in abstract form at the 2017 Society of Critical Care Medicine Conference in January 21-25, 2017, Honolulu, HI.

The authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies