Risk Factors for Prolonged Mechanical Ventilation After Repaired Tetralogy of Fallot in Children and Construction of the No-mogram

SHI Aiguo; BIAN Lanzheng; LI Mingxiong; MA Fangyan

doi:10.13730/j.issn.2097-2148.2024.01.010

Abstract：Objective To explore the risk factors for prolonged mechanical ventilation after repaired Tetralogy of Fallot in children and construct the nomogram.Methods A total of 117 children with Tetralogy of Fallot who received corrective procedure of Tetralogy in author's hospital from February 2021 to January 2023 were selected in this study,and children were divided into prolonged group(n=29)and non-prolonged group(n=88)according to whether mechanical ventilation was prolonged after surgery.The clinical data of the children were collected,and the influencing factors of prolonged mechanical ventilation after radical treatment of Tetralogy of Fallot were investigated by univariate and multiva-riate Logistic regression analysis;the nomogram was drawn to predict prolonged mechanical ventilationa,and the predic-tive value of the line graph for predicting mechanical ventilation duration extension were evaluated by receiver operating characteristic curve(ROC)curve.Results Mechanical ventilation duration prolonged in 29 cases(24.79％)of 117 chil-dren with repaired Tetralogy of Fallot.The body mass,height and oxygen saturation(SpO2)of the children in the pro-longed group were less than those in the non-prolonged group,and the proportion of systemic pulmonary artery collater-als,the proportion of pulmonary artery stenosis,the proportion of McGoon ratio＜1.5,C-reactive protein(CRP)level,the duration of extracorporeal circulation,the proportion of re-intubation,the length of intensive care unit(ICU)stay and the length of hospitalization were higher than those in the non-prolonged group(all P＜0.05).Multivariate Logistic regression analysis showed that body mass＜9.68 kg[OR=2.063.95％confidence interval(CI):1.461-2.912],systemic pulmonary artery collaterals(OR=2.646,95％CI:1.743-4.017),McGoon ratio＜1.5(OR=2.259,95％CI:1.545-3.304),preoperative SpO2＜94％(OR=2.790,95％CI:1.827-4.260)and the dura-tion of extracorporeal circulation ≥113 min(OR=3.435.95％CI:2.113-5.585)were the risk factors for prolonged mechanical ventilation after repaired Tetralogy of Fallot in children(P＜0.05).Prediction of nomogram of prolonged me-chanical ventilation after repaired Tetralogy of Fallot in children was constructed,the C-index was 0.746(95％CI:0.694-0.789).The predictive value of ROC curve on nomogram of prolonged mechanical ventilation after repaired Tetralogy of Fallot in children showed that the area under the curve(AUC)was 0.768,the specificity was 71.24％and the sensi-tivity was 77.49％(Z=10.237,P＜0.05).Conclusion The nomogram based on body mass,systemic pulmonary artery collaterals,McGoon ratio,preoperative SpO2 and the duration of extracorporeal circulation has a high predictive value for the risk of prolonged mechanical ventilation after repaired Tetralogy of Fallot in children.