168: DESCRIPTORS OF FAILED EXTUBATION IN NORWOOD PATIENTS USING PHYSIOLOGIC DATA STREAMING

Objective: To evaluate the utility of high-frequency physiologic data during the extubation process and other clinical variables for describing the physiologic pro�le of extubation failure in neonates with hypoplastic left heart syndrome (HLHS) post-Norwood procedure. Methods: Single-center, retrospective analysis. Extubation events were collected from January 2016 until July 2021. Extubation failure was de�ned as the need for re-intubation within 48 hours of extubation. The data included streaming heart rate, respiratory rate, blood pressure, arterial oxygen saturation, and cerebral/renal near-infrared spectroscopy (NIRS). The most recent blood laboratory results before extubation were also included. These markers, demographics, clinical characteristics, and ventilatory settings were compared between successful and failed extubations. Results: The analysis included 311 extubations. The extubation failure rate was 10%. According to univariate analyses, failed extubations were preceded by higher respiratory rates (p=0.029), lower end-tidal CO2 (p=0.009), lower pH (p=0.043), lower serum bicarbonate (p=0.030), and lower partial pressure of O2 (p=0.022). In the �rst 10 minutes after extubation, the failed events were characterized by lower arterial (p=0.028) and cerebral NIRS (p=0.018) saturations. Failed events were associated with persistently lower values for cerebral NIRS 2 hours post-extubation (p=0.027). In multivariate analysis, vocal cord anomaly, cerebral NIRS at 10 minutes post-extubation, renal NIRS at pre-extubation and post-extubation, and end-tidal CO2 at pre-extubation remained as signi�cant co-variates. Conclusions: Oximetric indices before, in the 10 minutes immediately after, and 2 hours after extubation and vocal cords paralysis are