Learning From Experience

Improving Early Tracheal Extubation Success After Congenital Cardiac Surgery

Peter D. Winch, MD, MBA; Anna M. Staudt, MD; Roby Sebastian, MD; Marco Corridore, MD; Dmitry Tumin, PhD; Janet Simsic, MD; Mark Galantowicz, MD; Aymen Naguib, MD; Joseph D. Tobias, MD


Pediatr Crit Care Med. 2016;17(7):630-637. 

In This Article


Our past experience reflected in a previous publication documented our success with the early tracheal extubation strategy, but as demonstrated herein, it also left room for further improvement. This most recent retrospective examination has not only demonstrated ongoing success of early tracheal extubation following surgery for congenital heart disease, but more importantly has identified that agitation and delirium may be important risk factors for failure of early tracheal extubation. This may provide an opportunity to further improve upon our care by modifying our postoperative approach to analgesia. By incorporating a more holistic parental presence in the CTICU, we might be able to further improve outcomes of early tracheal extubation, and, in the process, improve our patient care.

Using information from both this study and our prior publication, we continue our endeavor to improve our practice of early tracheal extubation. We have improved our success rate of early tracheal extubation in small infants, which is demonstrated to be safe and achievable for patients undergoing both CPB and non-CPB procedures. Additional characteristics predicting failed tracheal extubation were not identified, although the small number of failures limited analyses further differentiating patients who required reintubation. However, we believe that agitation or delirium is unique in this population of infants and may lead to failure of tracheal extubation during the first 24 hours. As data collection and review continue, more robust predictive indicators may become apparent. As a result of this review, which involved critically evaluating patients who failed early tracheal extubation, we are now reevaluating our approach to postoperative analgesia and sedation in the CTICU setting.