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Severe Upper Airway Obstruction After Intraoperative Transesophageal Echocardiography in Pediatric Cardiac Surgery: A Retrospective Analysis*

Michel, Jörg MD1; Hofbeck, Michael MD1; Schineis, Christian MD1; Kumpf, Matthias MD1; Heimberg, Ellen MD1; Magunia, Harry MD2; Schmid, Eckhard MD2; Schlensak, Christian MD3; Blumenstock, Gunnar MD4; Neunhoeffer, Felix MD1

Pediatric Critical Care Medicine: October 2017 - Volume 18 - Issue 10 - p 924-930
doi: 10.1097/PCC.0000000000001252
Cardiac Intensive Care
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Objectives: The aim of this study was to evaluate if there is a correlation between the use of intraoperative transesophageal echocardiography and an increased rate of extubation failure and to find other risk factors for severe upper airway obstructions after pediatric cardiac surgery.

Design: Retrospective analysis.

Setting: Cardiac PICU.

Patients: Patients 24 months old or younger who underwent surgery for congenital heart disease with cardiopulmonary bypass were retrospectively enrolled and divided into two groups depending on whether they received an intraoperative transesophageal echocardiography or not. We analyzed all cases of early reintubations within 12 hours after extubation due to a documented upper airway obstruction.

Intervention: None.

Measurements and Main Results: From a total of 424 patients, 12 patients (2.8%) met our criteria of early reintubation due to upper airway obstruction. Ten of 207 children in the transesophageal echocardiography group had to be reintubated, whereas only two of the 217 children in the control group had to be reintubated (4.8% vs 0.9%; p = 0.018). Logistic regression analysis showed a significant correlation between use of intraoperative transesophageal echocardiography and extubation failure (odds ratio, 5.64; 95% CI, 1.18–27.05; p = 0.030). There was no significant relationship among sex (odds ratio, 4.53; 95% CI, 0.93–22.05; p = 0.061), weight (odds ratio, 1.07; 95% CI, 0.82–1.40; p = 0.601), duration of surgery (odds ratio, 1.04; 95% CI, 0.74–1.44; p = 0.834), duration of mechanical ventilation (odds ratio, 1.00; 95% CI, 0.99–1.00; p = 0.998), and occurrence of trisomy 21 (odds ratio, 3.47; 95% CI, 0.83–14.56; p = 0.089).

Conclusions: Although the benefits of intraoperative transesophageal echocardiography during pediatric cardiac surgery are undisputed, it may be one factor which could increase the rate of severe upper airway obstruction after extubation with the need for reintubation. We suggest to take precautions before extubating high-risk patients, especially in young male children with genetic abnormalities after cardiac surgery with cardiopulmonary bypass.

1Department of Pediatric Cardiology, Pulmology, and Pediatric Intensive Care Medicine, University Children’s Hospital Tuebingen, Tuebingen, Germany.

2Department of Anesthesiology and Intensive Care Medicine, University Hospital Tuebingen, Tuebingen, Germany.

3Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tuebingen, Tuebingen, Germany.

4Institute for Clinical Epidemiology and Applied Biometry, Eberhard Karls University Tuebingen, Tuebingen, Germany.

*See also p. 988.

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

The study protocol was approved by the Ethics Committee of Tuebingen University Hospital (217/2016BO2).

For information regarding this article, E-mail: joerg.michel@med.uni-tuebingen.de

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies