Effect of Hypoxemia in the Determination of Short-Term Prognosis of Coronary Artery Bypass Graft Patients: A Prospective Study

Abstract

Background Respiratory failure and hypoxemia are the known complications of anesthesia and surgery. As a major surgery mainly at advanced ages, the coronary artery bypass graft (CABG) surgery could lead to hypoxemia in the early post-operative phase. Currently, the fraction of partial pressure of arterial oxygen to the fraction of inspired oxygen (PiO 2 /FiO 2 ) is used to determine the severity of the respiratory assault. Objectives This study aimed to find the effect of hypoxemia measured by PaO 2 /FiO 2 at the first hour following CABG in the determination of short-term prognosis of CABG. Methods Being approved by a local ethics committee, this observational cross-sectional study was conducted in 212 patients undergoing CABG on the cardiopulmonary pump, with no concurrent surgery or other cardiac pathologies. Factors like age, sex, weight, height, the duration of pump and cross-clamp, as well as other medical conditions including chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), opioid use, ejection fraction (EF), and creatinine clearance (CrCl) before the surgery were brought into consideration as possible confounders. The ratio of PiO 2 /FiO 2 in the first hour after the surgery was measured, and its effect on intubation time and intensive care unit (ICU) length of stay was evaluated as the primary outcomes. The t -test and chi-squared were used to compare quantitative and qualitative variables, respectively. The repeated measures ANOVA test was used to compare the means. Results There was no significant relationship between hypoxemia measured as the ratio of PaO 2 /FiO 2 and the duration of ICU length of stay (P value = 0.220) and the total intubation time (P value = 0.661). Among the qualitative variables, just opium addiction in patients with PaO 2 /FiO 2 > 300 was associated with significantly longer intubation time (P value = 0.016). Furthermore, in the quantitative variables, longer intubation time was associated with higher cross-clamp time (P value = 0.035) in hypoxemia in the range of ARDS patients. Conclusions Hypoxemia after the CABG surgery is common and does not affect the short-term prognosis of CABG patients.

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“…The process of weaning the patients from mechanical ventilation is of utmost importance for CABG patients (Elgebaly & Sabry, 2018) since the long‐term use of mechanical ventilation may not only increase the healthcare costs, but also may result in various adverse outcomes (Borges et al, 2017; Burns et al, 2019). There is a strong correlation between “intubation time” and “postoperative bleeding, readmission to the operating room, congestive heart failure, cardiac arrest, and hypotension” after the patient's condition has stabilized (Yousefshahi, Samadi, Paknejad, Bastan Hagh, & Aminzadeh, 2019). Hence, the reduction of intubation time would lead to reduced complications (Goodwin, Bissett, Mason, Kates, & Weber, 1999).…”

“…There is a strong correlation between "intubation time" and "postoperative bleeding, readmission to the operating room, congestive heart failure, cardiac arrest, and hypotension" after the patient's condition has stabilized (Yousefshahi, Samadi, Paknejad, Bastan Hagh, & Aminzadeh, 2019). Hence, the reduction of intubation time would lead to reduced complications (Goodwin, Bissett, Mason, Kates, & Weber, 1999).…”

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Clinical Applications of Aspirin as a Multi-potent Drug Beyond Cardiovascular Implications: A Proof of Concept for Anesthesiologists- A Narrative Review

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