Speakers - 2027

Title: Utility of extravascular lung water assessment and assessment of cardiac, lung and diaphragmatic functions by ultrasound to predict extubation outcomes in difficult to wean paediatric patients post cardiac surgery–A prospective observational cohort study

Abstract

Back ground and Aim :Congenital heart disease often require surgery and mechanical ventilation. While most patients are extubated within 48 hours, some face weaning difficulties due to complex cardiac conditions, comorbidities, or postoperative complications. This study aimed to assess clinical, ultrasound, and biochemical parameters to predict extubation outcomes in pediatric cardiac surgery patients who were difficult to wean.

Design: prospective, observational, control study

Setting: cardiac surgical intensive care unit (ICU) at the tertiary health care center and research institute

Methods : After ethical committee approval and written informed consent from the parents, participants were enrolled based on pre-defined inclusion and exclusion criteria. A total of 80 pediatric patients who underwent cardiac surgery were included  of which 60 met underwent the final analysis. A total 75% were successfully weaned from mechanical ventilation, while 25% experienced weaning failure. A significant association of age and weaning failure was observed (p = 0.038), with the highest failure rates seen in children under 1 year. Weaning failure was noted more in complex congenital heart disease (p=0.001) and children who underwent complex procedures ( p=0.0028).The mean RACHS score was significantly higher in the failed weaning  group (3.07 ± 0.88) than in the successful group (1.87 ± 0.34; p < 0.001), indicating greater procedural complexity in the former. Patients in the failed group had significantly longer CPB time (130.27 ± 69.21 vs 83.60 ± 31.29 mins; p = 0.001), surgery duration (5.73 ± 2.05 vs. 4.51 ± 1.12 hrs; p = 0.005), and mechanical ventilation duration (74.13 ± 26.50 vs. 9.16 ± 3.70 hrs; p < 0.001). ICU and hospital stays were also significantly longer in the failed group (p < 0.001 for both).All patients in the failed group were managed with PRVC mode ventilation, compared to 88.89% in the successful group. However, ventilator mode and SBT technique did not show significant differences. Respiratory and CNS comorbidities were present exclusively in the failed group (p < 0.001). Additionally, 66.67% of failed patients had two organ dysfunctions and 33.33% had more than three, compared to 88.89% of successful patients who had none.Severity scores (APACHE II and SOFA) were significantly elevated in the failed group (p < 0.001). These patients also had higher RSBI and lactate levels and more positive fluid balance both cumulatively and in the 24 hours before SBT. Lung ultrasound scores were higher, while diaphragmatic thickening and thickening fractions were lower in the failed group. Echocardiographic parameters revealed lower LVEF and more deranged diastolic function indices (E/A, E/e’, deceleration time) among those who failed.  (p < 0.001 in each).

Conclusion :The study concludes that patients who failed weaning demonstrated higher organ severity scores (APACHE II, SOFA,RACH), elevated extravascular lung water , impaired diaphragmatic function, compromised systolic and diastolic function and co-morbidities. Overall, the study supports the integration of bedside ultrasound, particularly lung and cardiac sonography, along with traditional clinical markers, in guiding extubation decisions in complex pediatric cardiac surgery cases.