Iranian Journal of Pediatrics

Published by: Kowsar

The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

Omer Faruk Savluk 1 , * , Fusun Guzelmeric 1 , Yasemin Yavuz 1 , Muhammet Akyuz 2 , Deniz Cevirme 2 , Aybala Tongut 2 , Baburhan Ozbek 2 , Ali Can Hatemi 2 and Hakan Ceyran 2
Authors Information
1 Kartal Kosuyolu High Training and Education Hospital, Anesthesiology and Reanimation Clinic, Denizer street.Cevizli, Kartal, Istanbul
2 Kartal Kosuyolu High Training and Education Hospital, Pediatric Cardiovascular Surgery Clinic
Article information
  • Iranian Journal of Pediatrics: October 2017, 27 (5); e9416
  • Published Online: October 23, 2017
  • Article Type: Research Article
  • Received: October 20, 2016
  • Revised: June 6, 2017
  • Accepted: July 20, 2017
  • DOI: 10.5812/ijp.9416

To Cite: Faruk Savluk O, Guzelmeric F, Yavuz Y, Akyuz M, Cevirme D, et al. The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery, Iran J Pediatr. 2017 ; 27(5):e9416. doi: 10.5812/ijp.9416.

Copyright © 2017, Iranian Journal of Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Anitha F, Lakshmi S, Darlington C, Vinoth S. Clinical profile of children mechanically ventilated in a pediatric intensive care unit of limited resource setting. Int J Contemp Pediatr. 2016; 3(2): 542-5
  • 2. Thiagarajan RR, Bratton SL, Martin LD, Brogan TV, Taylor D. Predictors of successful extubation in children. Am J Respir Crit Care Med. 1999; 160(5 Pt 1): 1562-6[DOI][PubMed]
  • 3. Khan N, Brown A, Venkataraman ST. Predictors of extubation success and failure in mechanically ventilated infants and children. Crit Care Med. 1996; 24(9): 1568-79[PubMed]
  • 4. Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013; 88(1): 218-30[DOI][PubMed]
  • 5. Harris KC, Holowachuk S, Pitfield S, Sanatani S, Froese N, Potts JE, et al. Should early extubation be the goal for children after congenital cardiac surgery? J Thorac Cardiovasc Surg. 2014; 148(6): 2642-7[DOI][PubMed]
  • 6. Tabbutt S. Can multicenter registries determine the optimal timing of extubation after congenital heart surgery? J Thorac Cardiovasc Surg. 2016; 151(2): 458-9[DOI][PubMed]
  • 7. Gaies M, Tabbutt S, Schwartz SM, Bird GL, Alten JA, Shekerdemian LS, et al. Clinical Epidemiology of Extubation Failure in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium. Pediatr Crit Care Med. 2015; 16(9): 837-45[PubMed]
  • 8. Gupta P, Rettiganti M, Gossett JM, Yeh JC, Jeffries HE, Rice TB, et al. Risk factors for mechanical ventilation and reintubation after pediatric heart surgery. J Thorac Cardiovasc Surg. 2016; 151(2): 451-8 e3[DOI][PubMed]
  • 9. Manrique AM, Feingold B, Di Filippo S. Extubation after cardiothoracic surgery in neonates, children, and young adults: One year of institutional experience. Pediatr Crit Care Med. 2007; 8: 552-5
  • 10. Edmunds S, Weiss I, Harrison R. Extubation failure in a large pediatric ICU population. Chest. 2001; 119(3): 897-900[PubMed]
  • 11. Berkowitz DH, Gaynor JW. Pediatric cardiac surgery. 2013; : 169-213
  • 12. Brix-Christensen V. The systemic inflammatory response after cardiac surgery with cardiopulmonary bypass in children. Acta Anaesthesiol Scand. 2001; 45(6): 671-9[PubMed]
  • 13. Schuller JL, Bovill JG, Nijveld A, Patrick MR, Marcelletti C. Early extubation of the trachea after open heart surgery for congenital heart disease. A review of 3 years' experience. Br J Anaesth. 1984; 56(10): 1101-8[PubMed]
  • 14. Mittnacht AJ, Thanjan M, Srivastava S, Joashi U, Bodian C, Hossain S, et al. Extubation in the operating room after congenital heart surgery in children. J Thorac Cardiovasc Surg. 2008; 136(1): 88-93[DOI][PubMed]
  • 15. Ranucci M, Isgro G, Carlucci C, De La Torre T, Enginoli S, Frigiola A, et al. Central venous oxygen saturation and blood lactate levels during cardiopulmonary bypass are associated with outcome after pediatric cardiac surgery. Crit Care. 2010; 14(4)[DOI][PubMed]
  • 16. Epstein SK. Decision to extubate. Intensive Care Med. 2002; 28(5): 535-46[DOI][PubMed]
  • 17. Lessard MR, Brochard LJ. Weaning from ventilator support. Clin Chest Med. 1996; 17: 475-89
  • 18. Parker MM. Predicting success of extubation in children. Crit Care Med. 1996; 24(9): 1429-30[PubMed]
  • 19. Sillos EM, Veber M, Schulman M, Krauss AN, Auld PA. Characteristics associated with successful weaning in ventilator-dependent preterm infants. Am J Perinatol. 1992; 9(5-6): 374-7[DOI][PubMed]
  • 20. Aleksandrova NP. Cytokines and resistive breathing. Hum Physiol. 2012; 38(2): 217-25[DOI]
  • 21. Papanicolaou DA, Petrides JS, Tsigos C, Bina S, Kalogeras KT, Wilder R, et al. Exercise stimulates interleukin-6 secretion: inhibition by glucocorticoids and correlation with catecholamines. Am J Physiol. 1996; 271(3 Pt 1): 601-5[PubMed]
  • 22. Vassilakopoulos T, Roussos C, Zakynthinos S. The immune response to resistive breathing. Eur Respir J. 2004; 24(6): 1033-43[DOI][PubMed]
  • 23. Sellares J, Loureiro H, Ferrer M, Amaro R, Farre R, Torres A. The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning. Eur Respir J. 2012; 39(3): 654-60[DOI][PubMed]
  • 24. Nathan C. Neutrophils and immunity: challenges and opportunities. Nat Rev Immunol. 2006; 6(3): 173-82[DOI][PubMed]
  • 25. Ordonez-Rueda D, Jonsson F, Mancardi DA, Zhao W, Malzac A, Liang Y, et al. A hypomorphic mutation in the Gfi1 transcriptional repressor results in a novel form of neutropenia. Eur J Immunol. 2012; 42(9): 2395-408[DOI][PubMed]
  • 26. Smith GS, Lumsden JH. Review of neutrophil adherence, chemotaxis, phagocytosis and killing. Vet Immunol Immunopathol. 1983; 4(1-2): 177-236[DOI]
  • 27. Menges T, Engel J, Welters I, Wagner RM, Little S, Ruwoldt R, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications. Crit Care Med. 1999; 27(4): 733-40[PubMed]
  • 28. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001; 102(1): 5-14[PubMed]
  • 29. Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012; 34(2): 155-9[DOI][PubMed]
  • 30. Ridker PM, Rifai N, Pfeffer M, Sacks F, Lepage S, Braunwald E. Elevation of tumor necrosis factor-alpha and increased risk of recurrent coronary events after myocardial infarction. Circulation. 2000; 101(18): 2149-53[PubMed]
Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments