Postextubation Arterial Blood Gas to Predict Reintubation in Children With Congenital Heart Disease.

BACKGROUND: Children with cardiac disease frequently receive mechanical ventilation. Drawing an arterial blood gas (ABG) 1-2 h postextubation is common practice. Limited data exist evaluating the utility of ABGs in this context. We hypothesized that postextubation acidemia would be associated with reintubation. METHODS: We retrospectively evaluated all patients with an ABG postextubation in the pediatric cardiac intensive care unit (PCICU) between June 2022 and December 2024. We defined acidemia as an arterial pH <7.35. Our primary outcome was reintubation within 48 h. Secondary outcomes included duration of noninvasive respiratory support (NRS) and hospital stay. RESULTS: We studied 718 subjects, and 91 (13%) had acidemia. Subjects with postextubation acidemia were more likely to be reintubated (21% vs 7.3%, P < .001) and spent longer on NRS (6.7 [2.8-15.9] vs 4.6 [2.2-10.9] days, P = .036). Hospital and PCICU stay were similar. Prior to extubation, demographics, medical history, and surgical history showed no differences, except subjects with acidemia more frequently had delayed sternal closure (34% vs 20%, P = .007) and single ventricle physiology (40% vs 27%, P = .009). Pre-extubation variables were similar between groups. Subjects with acidemia had higher median pre-extubation 24-h fluid balance, higher median 48-h fluid balance, higher final extubation readiness test (ERT) breathing frequency (39 [32-47] vs 35 [26-44] breaths/min, P = .01), lower final ERT tidal volume (6.7 [5.4-7.6] vs 7.1 [6.0-8.3] mL/kg, P = .004), more frequent upper airway obstruction (26% vs 9.4%, P < .001), and required higher NRS at 24, 48, and 72 h after extubation. Logistic regression identified acidemia (odds ratio [OR] 2.8, 95% CI [1.4-5.6], P = .004), ventricular assist device placement (OR 30.2, 95% CI [2.3-396.9], P = .009), and final ERT breathing frequency (OR 1.03, 95% CI [1.01-1.06], P = .006) as factors associated with reintubation. CONCLUSIONS: Eighty percent of subjects with postextubation acidemia did not require reintubation, but acidemia was associated with a 3-fold increased risk of reintubation.

Duke Scholars

Author Alexandre Tellechea Rotta Pediatrics, Critical Care Medicine

Author Katherine Cashen Pediatrics, Critical Care Medicine

Author Veerajalandhar Allareddy Pediatrics, Critical Care Medicine

Author Joseph Zakhar Pediatrics, Critical Care Medicine