Clinical Strategies to Prevent Pulmonary Complications in Cardiac Surgery: An Overview

Ubben, Johannes F. H.; Lancé, Marcus D.; Buhre, W.; Schreiber, Jan-Uwe

doi:10.1053/j.jvca.2014.09.020

Cited by 21 publications

(13 citation statements)

References 87 publications

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“…As stated, pulmonary complications are an unavoidable complication following CABG surgery [15,16]. Various studies have shown a different outbreak in patients ranging from 3 to more than 50% [17,18].…”

Section: Pulmonary Complications Following Cardiac Surgerymentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.

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Section: Pulmonary Complications Following Cardiac Surgerymentioning

confidence: 99%

Pulmonary complications following cardiac surgery

Mali¹,

Haghaninejad²

2019

Arch Med Sci Atheroscler Dis

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“…Pneumonia is the most common serious infection occurring after cardiac surgery, and represents a major source of noncardiac mortality in the postoperative setting 1 . The etiology of postoperative pneumonia among cardiac surgery patients is multifactorial and encompasses systemic changes following cardiopulmonary bypass, perioperative fluid administration, blood transfusion, prolonged mechanical ventilation, and decreased inspiratory volumes secondary to painful respiration and altered chest wall mechanics 1‐3 …”

Section: Introductionmentioning

confidence: 99%

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

et al. 2020

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Background The development of postoperative pneumonia following cardiac surgery is associated with significant morbidity and mortality. However, seasonal variation as a risk factor for the development of postoperative pneumonia remains to be investigated. We sought to investigate whether patients undergoing coronary artery bypass grafting (CABG) during “flu season” (Fall and Winter months) at increased risk of postoperative pneumonia. Materials and Methods A retrospective cohort study of patients undergoing CABG in the National Inpatient Sample between 2005 and 2015 was completed. Concomitant diagnosis of pneumonia was defined as the primary outcome. Secondary outcomes were defined to include pneumonia secondary to several known pathogens. Outcomes with significant differences between Fall/Winter and Spring/Summer groups were further analyzed with additive time series decomposition. Odds ratios were generated and adjusted for age, sex, elective status, and 29 other Agency for Healthcare Research and Quality comorbidity measures. Results A total of 238 757 and 277 941 patients undergoing CABG during Fall/Winter and Spring/Summer, respectively, were identified. A significantly increased risk of postoperative pneumonia (adjusted odds ratio [aOR] = 1.15) and infection with influenza (aOR = 4.08), Haemophilus influenzae (aOR = 1.40), and Streptococcus pneumoniae (aOR = 1.47) was observed among patients receiving CABG in Q1 (January‐March) compared to Q3 (July‐September). Conclusions There is a strong seasonality in the incidence of postoperative pneumonia after CABG which may persist across other cardiothoracic surgeries. In addition to optimizing infection control and perioperative care, cardiac surgeons should consider preoperative vaccination against seasonal influenza, H. influenzae, and S. pneumoniae to improve outcomes among high‐risk patients.

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“…[17] However, the adverse effects of PST on liver outcomes among cardiac surgical populations still need to be investigated further. Besides, respiratory complications after CABG are common, with an occurrence of 10 to 25% [18]. However, the independent relationship between PST and respiratory complications has not been confirmed because of a paucity of data [8].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Statins before High-Risk CABG on Postoperative Multiple Organ Function

Wang

Yuan

Zhang

et al. 2020

Cardiology Research and Practice

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Background. The purpose of this cohort study was to investigate the independent relationship between preoperative statin therapy (PST) and postoperative severe multiorgan failure, measured by the Sequential Organ Failure Assessment (SOFA) maximum greater than 11, in high-risk patients undergoing isolated coronary artery bypass grafting (CABG). Methods. The present study is a perspective, single-center, cohort analysis enrolling high-risk patients undergoing CABG from Jan 1, 2018, to Dec 31, 2018, in Beijing Anzhen hospital. Results. Among a total of 880 high-risk patients undergoing isolated CABG included in this study, 503 (57.2%) experienced statin therapy before CABG. The SOFA maximum was significantly lower in the PST group compared with the control group (7.8 ± 3.0 v 9.2 ± 3.4, P<0.0001). Multivariate logistic regression analysis demonstrated the incidence of the severe multiorgan dysfunction, measured by SOFA maximum ≥11, was dramatically reduced in the PST group (OR, 0.68, 95% CI 0.50–0.92, P=0.013). Furthermore, preoperative statin therapy (PST) might be associated with a decreased risk of postoperative major adverse cardiovascular and cerebral events and acute kidney injury, but an increased risk of postoperative hepatic inadequacy. Conclusion. SOFA maximum was significantly lower in the PST group compared with the control group and the incidence of the severe multiorgan dysfunction was dramatically reduced in the PST group. The findings of this study might shed new light on questions of positive or negative effects of PST on multiple organ function after high-risk CABG, so as to ultimately improve high-risk patient in-hospital outcomes from CABG.

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Clinical Strategies to Prevent Pulmonary Complications in Cardiac Surgery: An Overview

Cited by 21 publications

References 87 publications

Pulmonary complications following cardiac surgery

Pulmonary complications following cardiac surgery

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

The Impact of Statins before High-Risk CABG on Postoperative Multiple Organ Function

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