Factors affecting reintubations after cardiac and thoracic surgeries in cardiac intensive care unit of a tertiary care hospital

Abstract

Background:Reintubation and readmission after cardiothoracic surgeries are not uncommon, and its reasons are multifactorial. The study goal was to identify the factors that contribute reintubation after cardiac and thoracic surgery in tertiary care hospital and to compare the outcome with international benchmark.Methodology:A prospective, observational study was planned in Cardiac Intensive Care Unit (CICU). The study included all those patients who required readmission in CICU due to endotracheal intubation following cardiac and thoracic surgeries. The study was conducted from January to December 2016. The primary focus was to identify the reasons for reintubation within 72 h of extubation after CICU discharge and its association with outcome.Results:Out of 750 patients who shifted out from CICU following successful extubation, only 32 were readmitted and among them in 25 patients (3.33%) were reintubated and their reasons reintubation were noted. Patients underwent a coronary artery bypass grafting (CABG) with valve replacement had a higher incidence of reintubation 3/39 (7.69%) when compared with CABG 13/517 (2.51%) and 4/135 (2.96%) valve procedure alone. Single cause of endotracheal reintubation was observed in 7 patients (28%), in which 5 patients (20%) had respiratory and 2 patients had (8%) cardiac reason while 18 patients (72%) were observed with multisystem involvement, in which 7 patients (28%) had both respiratory and cardiovascular causes, and 2 (8%) had both respiratory and neurological causes. More than 70% cause of endotracheal reintubation was both respiratory and cardiovascular. The CICU stay after reintubations was 12.88 ± 16.88 days and the hospital stay prolonged to 23.84 ± 21.61 days.Conclusion:Reasons of reintubation were mainly respiratory and cardiac. The rate of reintubations is high when multisystem involvement is there. CICU, hospital stay, and mortality are increases after reintubation.

An Evidence-Based Approach to Non-Invasive Ventilation in Cardiac Rehabilitation after Coronary Artery Bypass Grafting (CABG)

“…The measured values in the NIV group were 2.64, 0.99, 1.53, and 1.94 before the operation, immediately after extubation, and 24 and 48 hours after extubation, respectively. In contrast, the control group had values of 2.11, 0.90, 0.90, and 0.97 [20]. The NIV group exhibited superior performance as a result of the patient's active engagement in generating deep breaths, thereby mitigating discomfort experienced during physical exertion.…”

Incidence and Causes of Reintubation Other Than Reopening of the Chest in Post-Cardiac Surgical Patients in a Tertiary Care Hospital

“…Despite the significant improvement seen in cardiac surgical techniques and perioperative care in recent years, postoperative endotracheal reintubation is not uncommon for seriously ailing patients in the cardiac intensive care unit (CICU) after successful weaning from the ventilator [ 1 ]. Research describes the reintubation incidence, subsequent to planned extubation, to be in the range of 10-20% in the general intensive care unit (ICU) patients [ 2 ].…”