Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation

Early respiratory outcomes following cardiac surgery in patients with COVID‐19

“…This may be ex- Emergency or urgent surgery, old age, comorbidities, and high frailty scores are associated with a longer mechanical ventilation time in cardiac surgery patients. 18 The initial intubation time in the present study was not different from our non-COVID-19 cardiac surgery patients ( Table 3), indicating that the early respiratory course was unremarkable. We had only one case of extubation failure in the ICU.…”

“…This may be explained by the fact that our patients were asymptomatic and that postoperative anesthetics and residual muscular relaxants might affect the compliance and resistance of the lung. The median PEEP in our patients (6 cmH 2 O,[IQR, 5‐6]) was lower compared to the nonsurgical ICU COVID‐19 patients in the study by Grasselli et al 3 Emergency or urgent surgery, old age, comorbidities, and high frailty scores are associated with a longer mechanical ventilation time in cardiac surgery patients 18 . The initial intubation time in the present study was not different from our non‐COVID‐19 cardiac surgery patients (Table 3), indicating that the early respiratory course was unremarkable.…”

Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable?

“…Similarly, increasing utilization of cytokine absorbers may reduce high levels of inflammatory markers, and hemodynamic management with new drugs (eg, levosimendan, milrinone) and tools (eg, echocardiography, continuous cardiac output monitoring) may lead to a reduced incidence of postoperative cardiogenic shock and associated high arterial lactate levels despite of a prolonged cardiopulmonary bypass time. This would contradict the recent findings of Hessel et al 3 Finally, early addressing of modifiable risk factors that contribute to postoperative morbidity and mortality-within the scope of a cardiac prehabilitation-represent nowadays an individualized bundle of preoperative interventions, which positively affect the time on mechanical ventilation, the ICU and hospital length of stay, and the quality of life after cardiac surgery. 10 Because of the continuous improvements in patient care and changes in patient selection for cardiac surgery, it is a challenge to establish a valid prediction score based on retrospective data.…”

“…In the current issue of the Journal of Cardiothoracic and Vascular Anesthesia, Hessel et al present a predictive score for early identification of patients who are at high risk of prolonged mechanical ventilation (>24 hours) after cardiac surgery. 3 In their retrospective analysis of data provided by 2 national registries, the authors had access to a large volume of preoperative, intraoperative, and early postoperative clinical parameters, which were collected between 2013 and 2018 from all cardiothoracic surgery procedures at their institution. The initial part of the study, involving risk model development, was performed in 1,496 patients (75% of the study population) and provided variables for a predictive score.…”

The Effects of Escalation of Respiratory Support and Prolonged Invasive Ventilation on Outcomes of Cardiac Surgical Patients: A Retrospective Cohort Study

“…Several authors have reported outcomes related to prolonged invasive ventilation after cardiac surgery and developed prediction models mainly using 24-, 36-, or 48-hour thresholds for prolonged invasive ventilation. [26][27][28][29][30][31][32][33] The standard definition of prolonged invasive ventilation according the Society of Thoracic Surgeons is a duration exceeding 24 hours. 13 It has been shown that "time to extubation" after cardiac surgery longer than 16 hours predicts poor clinical outcomes (morbidity, mortality, and reintubation) and that liberation from the ventilator within the first 9 hours is a predictor of better postoperative outcomes.…”