Objectives: To identify the characteristics of infants with extubation failure post Modified Blalock-Taussig Shunt (MBTS) and to determine the incidence and predictors of extubation failure in this group of infants and to compare it with the international figures.Methods: A single-center retrospective cohort study of infants < 1 year of age who underwent MBTS at the pediatric cardiac intensive care unit at Royal Hospital, Oman, from January 2010 to December 2019. We excluded infants who died before extubation, infants with missing data, and infants who underwent another surgical intervention before extubation. Ethical approval was obtained from the scientific research committee at the Royal Hospital. All categorical variables were presented as numbers and percentages. Analyses were performed using SPSS version 25. Results: A total of 146 infants were included in the study. Extubation failure occurred in 27 (18.5%) patients. Among those who failed extubation, 18 (66.7%) patients were ventilated before the surgery with statistically significant p-value of 0.019. A systolic blood pressure (SBP) ≤ 50th percentile was associated with extubation failure. Infants with extubation failure had longer intensive care unit length of stay and longer hospital length of stay. Severe respiratory distress and hemodynamic instability were the two main reasons for re-intubation.Conclusions: The lower incidence rate (18.5%) for extubation failure might indicate higher quality performance of our institution. Prolonged mechanical ventilation, requirements for escalation of inotropes, and SBP ≤ 50th percentile might be as predictors for extubation failure in infants post MBTS. Extubation failure is associated with longer intensive care unit and hospital admission.
