A Standardized Extubation Schedule Reduces Respiratory Events After Extubation Following Mandibular Distraction in Infants

Purpose: The rational time for intubation during early mandibular distraction osteogenesis (MDO) in infants is unknown. To investigate the differences in clinical outcomes following MDO before and after a standardized extubation protocol implementation in infants. Methods: A retrospective cohort study was performed for infant patients under 1 year old undergoing MDO. The study population was composed of all patients presenting for evaluation and management who underwent MDO between November 2016 and February 2021. We divided them into 2 groups: the pre-protocol group and the protocol group. The inpatient charts of infants were assessed. The primary outcome was respiratory events after extubation. The secondary outcomes were duration of mechanical ventilation (MV), postoperative length of stay (LOS), and success rate of the first extubation. Other variables included age, sex, weight, height, and information related to diagnosis, distraction, anesthesia, and operation. The logistic regression model and linear regression model were used to calculate unadjusted and adjusted relative risk (RR) and mean difference (MD) for associations between 2 groups and the primary and secondary outcomes. Results: There were 142 infants in the pre-protocol group and 135 infants in the protocol group. The patients in the protocol group were heavier in weight than those inthepre-protocol group(P < .05). The Cormack-Lehane grade and the duration of operation and anesthesia were higher and longer in the pre-protocol group than in the protocol group (P < .05). Respiratory events after extubation were significantly more common in the pre-protocol group than in the protocol group[21.1 vs. 9.6%, adjusted relative risk 0.46 (95% CI0.22-0.89), P < .01]. Conclusions: Among infants undergoing MDO, the standardization of extubation practices can reduce respiratory events after extubation compared with traditional management. (C) 2021 The Author. Published by Elsevier Inc.