Variation in extubation failure rates after neonatal congenital heart surgery across Pediatric Cardiac Critical Care Consortium hospitals

Introduction: Poor physician wellness is associated with detrimental effects on patient outcomes. There are no data on physician wellness in pediatric cardiac critical care. We aimed to define the prevalence of and risk factors for impaired wellness using a targeted survey of the North American pediatric cardiac critical care workforce. Methods: We developed a survey to examine physician wellness and potential risk factors, incorporating the Expanded Physician Well Being Index. Unit directors at 120 congenital heart surgery centers were contacted to provide faculty emails. The survey was distributed to each faculty with targeted reminders from June - September 2019. Univariate and multivariable logistic regression analyses were performed comparing the at-risk respondents to those not at risk for poor wellness. Results: Of the 477 faculty, 294 completed the survey (62%). Faculty reported working a median of 83 hours on service weeks and 50 hours on non-service weeks. Based on Well-Being scores, 34% were in the “at risk” category; 56% reported feeling burned out in the past month and 46% reported feeling overwhelmed. However, 96% felt their work was meaningful. Faculty reported a high incidence of developing unhealthy habits including poor nutrition (50%), infrequent exercise (56%), and lack of self-care (46%). Factors associated with well-being risk are shown in Table 1. Poor interpersonal experiences, higher work hours, and being primarily trained in critical care with an additional cardiac year were associated with risk of poor wellness. Working >100 hours per service week had a significant increase in risk (odds ratio 2.3, 95% confidence interval 1.31-4.40). Availability of wellness services was associated with reduced risk. Conclusion: Burnout and risk of poor wellness are common in pediatric cardiac critical care faculty. Modifiable factors, including wellness service availability and reduced hours of clinical service may improve wellness in the workforce.

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Etiology and Risk Factors for Extubation Failure in Low Birth Weight Infants Undergoing Congenital Heart Surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2020.02.031 ◽

2020 ◽

Vol 34 (12) ◽

pp. 3361-3366

Author(s):

Chao Lu ◽

Jinfeng Wei ◽

Bin Cai ◽

Jiexian Liang ◽

Sheng Wang

Keyword(s):

Risk Factors ◽

Birth Weight ◽

Low Birth Weight ◽

Congenital Heart ◽

Heart Surgery ◽

Extubation Failure ◽

Congenital Heart Surgery ◽

Low Birth Weight Infants

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Synchronized Nasal Intermittent Positive Pressure Ventilation versus Nasal Continuous Positive Airway Pressure for Prevention of Extubation Failure in Infants after Congenital Heart Surgery

The Heart Surgery Forum ◽

10.1532/hsf.3515 ◽

2021 ◽

Vol 24 (2) ◽

pp. E249-E255

Author(s):

Yirong Zheng ◽

Jian-Feng Liu ◽

Yu-Qing Lei ◽

Hong-Lin Wu ◽

Hua Cao ◽

...

Keyword(s):

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Congenital Heart ◽

Heart Surgery ◽

Positive Pressure Ventilation ◽

Positive Airway Pressure ◽

Extubation Failure ◽

Congenital Heart Surgery ◽

Intermittent Positive Pressure Ventilation ◽

Positive Pressure

Objective: This study aimed to evaluate the application of synchronized nasal intermittent positive pressure ventilation (SNIPPV) in the respiratory weaning of infants after congenital heart surgery. Methods: We retrospectively analyzed the clinical data of 63 infants who were extubated from mechanical ventilation after congenital heart surgery between January 2020 and September 2020. The data, including demographics, anatomic diagnosis, radiology and laboratory test results, and perioperative variables were recorded. Results: The extubation failure rate within 48 h after extubation was significantly lower in the SNIPPV group than in the nasal continuous positive airway pressure (NCPAP) group. The PaO2 level and PaO2/FiO2 ratio within 48 h after extubation were higher in the SNIPPV group than in the NCPAP group (P < .05). Meanwhile, the PaCO2 level within 48 h was significantly lower in the SNIPPV group (P < .05). Compared with the NCPAP group, the median duration of postoperative noninvasive support and the duration from extubation to hospital discharge were shorter in the SNIPPV group; the total hospital cost was lower in the SNIPPV group. No significant differences were observed between the two groups concerning VAP, pneumothorax, feeding intolerance, sepsis, mortality, and other complications (P > .05). Conclusion: SNIPPV was shown to be superior to NCPAP in avoiding reintubation after congenital heart surgery in infants and significantly improved oxygenation and reduced PaCO2 retention after extubation. Further studies are needed to confirm the efficacy and safety of SNIPPV as a routine weaning strategy.

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