Factors associated to hypoxemia in patients undergoing coronary artery bypass grafting

Abstract

Introduction: Hypoxemia is a frequent pulmonary complication in the postoperative coronary artery bypass graft. Detection of factors associated with their occurrence may indicate patients at risk for this complication, which allows tracing specific therapeutic and consequently reduce morbidity and mortality.Objective: To identify related factors to hypoxemia occurrence in immediate coronary artery bypass graft postoperative.Methods: In this retrospective cohort study, we studied 100 patients submitted to elective om-pump artery bypass graft , between April 2010 and December 2011, at a reference university hospital for cardiac surgery in the state of Maranhão. It was considered hypoxemia gas exchange ratio less than or equal to 300 mmHg. Associated variables with perioperative hypoxemia were defined by the Student T test, G or Mann-Whitney tests, Chi-square, or Fisher's exact test and multiple linear regression.Results: Among studied variables, high body mass index (P=0.036) and smoking (P=0.024) were significantly associated with hypoxemia in the immediate coronary artery bypass graft postoperative. Hypoxemia incidence in this period was 55% and did not affects mechanical ventilation duration and Intensive Care Unit lengh of stay.Conclusion: In this sample, body mass index and smoking were associated to hypoxemia. These data reinforce the importance of clinical assessment to identify patients at risk for this complication, considering its high incidence in immediate postoperative period. Descriptors: Oxygen level. Postoperative period. Myocardial revascularization.Resumo Introdução: A hipoxemia é uma complicação pulmonar frequente no pós-operatório de revascularização miocárdica. A detecção de fatores associados a sua ocorrência pode indicar pacientes de risco para essa complicação, o que possibilita traçar terapêuticas específicas e, consequentemente, diminuir a morbimortalidade.Objetivo: Identificar fatores relacionados à ocorrência de hipoxemia no pós-operatório imediato de revascularização miocárdica.Métodos: Nesta coorte retrospectiva, foram estudados 100 365Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Rev Bras Cir Cardiovasc 2013;28(3):364-70Santos NP, et al. -Factors associated to hypoxemia in patients undergoing coronary artery bypass graftingAccording to a recent study [7], predictor factors detection may indicate patients at high risk for postoperative hypoxemia that demand mechanical ventilation strategies, in order to prevent and treat pulmonary collapse during intra-operatory period, to minimize hypoxemia impact on mechanical ventilation duration, to reduce mobidity and mortality related to cardiac intervention, to reduce length of stay at Intensive Care Unit (ICU), and hospital costs.This study is designed to analyze factors related to hypoxemia in a specific population of patients undergoing CABG surgery, to determine its incidence in immediate post-operative period, and to evaluate if hypoxemia interfered on mechanical ventilation duration and lengh of stay in ICU.

Elevated free fatty acid level is a risk factor for early postoperative hypoxemia after on-pump coronary artery bypass grafting: association with endothelial activation

“…Recent studies have shown that the main risk factors for hypoxemia after cardiac surgery are age, BMI, prolonged CPB time, smoking, reduced cardiac function, hypoalbuminemia, previous myocardial infarction, and history of cerebral vascular disease [ 14 – 18 ], In this study, multiple logistic regression analysis revealed that age, BMI and postoperative serum FFA levels were independently associated with early postoperative hypoxemia in patients undergone on-pump CABG. The present study for the first time demonstrated that serum FFA levels were significantly higher in the hypoxemia group than in the non-hypoxemia group, and that elevated FFA concentration was a risk factor for early postoperative hypoxemia after on-pump CABG, which may be closely associated with lung injury secondary to endothelial activation.…”

Metabotyping Patients’ Journeys Reveals Early Predisposition to Lung Injury after Cardiac Surgery

“…A patient’s medical history before cardiac surgery (e.g. age, health state, and smoking habits)42122, previous cardiac surgery23, the surgical procedure itself (general anaesthesia, sternotomy, atelectasis, and the use of CPB)424252627, and blood transfusion23 are well known risk factors of postoperative lung injury. Polymorphisms in the pro-inflammatory interleukin-encoding genes of IL-6 and IL-18 have been shown to predispose patients to CPB-induced acute lung injury2829.…”

Nível De Dor E Grau De Independência Funcional De Pacientes Submetidos À Cirurgia Cardíaca

“…In our study, a good cognitive situation was verified and this is an indication that these patients have potential to receive orientations and to execute the physical therapy techniques, helping in their postoperative improvement. Other studies (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) indicate that physical therapy integrates patient care with indication of cardiac surgery, both in the pre-and postoperative periods, using active and educative techniques in collaborative patients.…”

“…Cardiac surgery is often the most indicated option because it offers greater benefits in the medium and long term, as it pursues the return of the functional capacity of the heart based on the restoration and restitution of its vital functions (1) . Cardiac surgeries, the most common of which are reconstructive surgeries, myocardial revascularization and valve drainage are highly complex procedures that have important repercussions on the body and may cause clinical instability.…”