Frequency and determinants of reintubation following pediatric cardiac surgery

Background: Reintubation is a significant complication after pediatric cardiac surgery and is associated with increased morbidity and prolonged intensive care unit (ICU) stay. This study aimed to evaluate the incidence of reintubation and to identify the independent risk factors in this patient population. Methods: A retrospective analysis was performed across three tertiary centers between January 1, 2023, and January 1, 2025. Pediatric patients undergoing congenital heart surgery and monitored in the cardiac ICU were included. Demographic characteristics, operative details, and intensive care parameters were extracted from medical records. Reintubation was defined as the need for reintubation within 72 hours following initial extubation. Statistical analyses were conducted to determine predictors of reintubation. Results: Among 4.000 pediatric cardiac surgery patients, the reintubation rate was 4%, with most events occurring within 24 hours. In a matched cohort of 320 patients, reintubated patients more frequently had airway anomalies, genetic syndromes, newborn status, higher surgical complexity, and technical performance score (TPS)-3 scores. They also experienced longer mechanical ventilation, prolonged ICU and hospital stays. Multivariable analysis showed independent associations between reintubation and airway anomalies, genetic syndromes, newborn status, risk adjustment for congenital heart surgery-1 ≥4, TPS-3, pre-extubation extracorporeal membrane oxygenation support, diaphragm paralysis or vocal cord dysfunction, and sternal closure ≥2 days. Mortality did not differ between groups. Conclusion: The incidence of reintubation after pediatric cardiac surgery remains relatively high, with multifactorial underlying causes. The identification of these potential risk factors may facilitate the detection of high-risk patients following cardiac surgery and contribute to improved clinical outcomes by ensuring a more cautious approach to extubation in these groups.