Polito et al identified a number of perioperative factors associated with prolonged mechanical ventilation following surgery for complex congenital heart disease performed on a pediatric patient. These can help to identify a patient who may require more aggressive management. The authors are from Children's Hospital Boston, Bambino Gesu Children's Hospital in Rome and Brigham and Women's Hospital.


Patient selection: pediatric patient undergoing surgery for complex congenital heart disease (RACHS-1 >= 3)


Prolonged mechanical ventilation was for >= 7 days.


Risk factors for prolonged mechanical ventilation from the multivariate analysis:

(1) age < 30 days

(2) higher PRISM III score on admission to the cardiac ICU (mean 13)

(3) major noncardiac structural anomalies

(4) healthcare associated infection (HAI)

(5) pleural effusion, pneumothorax or other noninfectious pulmonary complications

(6) need for reintervention following the initial surgery


The risk for prolonged mechanical ventilation increased with the number of risk factors present.


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