Clinical and echocardiographic risk factors for extubation failure in infants with congenital diaphragmatic hernia.

Infants are at a high risk for extubation failure after surgical correction of Congenital diaphragmatic hernia. This study looks at some of the contributing factors.

34 infants with Congenital diaphragmatic hernia who had an echocardiogram within 48 hrs before first intubation and if reintubated, at the final extubation attempt, were included in the study.They were divided in to the successful extubation and failure to extubate groups. Extubation failure or need for reintubation was defined as SPO2 less then 80% despite oxygen supplementation, hypercapnia or signs of respiratory distress. Extubation failure occurred in 35% of the infants (compared with 5.8% of post cardiac surgery infants in intensive care). 50 % of these were successfully extubated 7 days after the reintubation.

Factors identified in this study as being associated with failure of extubation were: higher incidence of intrathoracic liver herniation, increased rates of ECMO, reduced lung- head ratio, raised mean airway pressure and higher FIO2 requirement prior to extubation. Failure was also associated with administration of Sildanefil, a higher incidence of vasoactive ionotrope use and pulmonary hypertension. The failure to extubate group also had an overall higher incidence of cardiac dysfunction.

Take home message:
This study has identified multiple factors that may be associated with a higher incidence of failure to extubate in these high-risk infants. However the study is retrospective and the echocardiographic assessment was within a varied period of 48 hours prior to extubation attempt, which may have altered some findings.

Reviewed by: Dr. Priya Sreedharan