PROLONGED ENDOTRACHEAL INTUBATION AFTER O PEN-HEART-SURGERY BEFORE ONE-YEAR OF AGE

The aim of this study was to determine the impact of prolonged endotra cheal intubation after open heart surgery in neonates and babies with respect to the cardiac diseases most frequently responsible and the re asons for delayed extubation and the related mortality. Intubation was considered to be prolonged if lasting over 48 hours. This was a retro spective study of all cases of open heart surgery performed before one year of age between 1991 and 1996. Prolonged intubation was noted in 43.1 % of cases (266/617). The frequency was much higher than in child ren over 1 year of age: 8.3 % (56/725). Truncus arteriosus (93.5 %: 29 /31), obstructed total anomalous venous drainage (93.3 %: 14/15), Taus sig-Bing anomaly (83.3 % : 5/6). interruption of the aortic arch (78.9 %: 15/19), double outlet right ventricle (61.1 %: 11/18) and transpos ition of the great arteries (50.2 %: 107/213) were the commonest respo nsible malformations. The reasons for delayed extubation, often multip le, were established in 222 cases: cardiogenic shock or circulating fa ilure in 155 cases, pulmonary dysfunction in 142 cases, surgical compl ications in 65 cases and neurological complications in 14 cases. Twelv e patients died: 5 of congestive heart failure, 3 of pulmonary hyperte nsion, 2 of septic shock and 1 of diffuse stenosis of the pulmonary ve ins. The mortality rate was 4.5 % (12/266) in cases of prolonged intub ation and 5.2 % (32/617) for all infants operated during the first yea r of life. The authors conclude that a large number of infants undergo ing open heart surgery undergo prolonged intubation because of their p oor preoperative status and the particularly severe effects of cardiop ulmonary bypass at this age. However, the associated mortality was low in this series.