Application of noninvasive ventilation in preventing extubation failure in children with heart disease: Key topics and clinical implications

Abstract

Surgery for congenital heart disease using cardiopulmonary bypass usually requires postoperative mechanical ventilation. The incidence of failed extubation after pediatric cardiac surgery is greater compared with that in the general pediatric population. Common causes in children with heart disease that contribute to extubation failure include lung disease, cardiac dysfunction, diaphragmatic paralysis, airway edema, and vocal cord paralysis. When urgent reintubation is required, this may produce substantial hemodynamic instability, increased risk for nosocomial infections, and prolonged mechanical ventilation and intensive care unit length of stay. Noninvasive ventilation has been used as a preventive measure in patients with high risk for extubation failure and can be effectively applied as an alternative means of respiratory support in patients with hypoxemic or hypercarbic failure with signs of respiratory distress who were considered likely to require reintubation after cardiac surgery. Decreased functional residual capacity that is repeatedly present in patients after cardiac surgery can be improved with continuous positive airway pressure. This improvement can be increased by additional pressure support and/or pressure-controlled breaths, which can help preserve good lung volume and reduce the load of the inspiratory muscles and the work of breathing.