Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation

Abstract

Background: Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3-4) and patients with normal renal function (reference group). Methods: This is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery. Results: Patients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation. Conclusions: Fluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.

The Overall Prevalence and Main Determinants of Prolonged Mechanical Ventilation in Patients Undergoing Coronary Artery Bypass Grafting: A Systematic Review

“…Of those, 8 were also excluded due to the incompleteness of the data and contents. 15 articles were eligible for the final analysis[ 6 9 10 11 12 13 14 15 16 17 18 19 20 21 22 ] [ Table 1 ].…”

Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia

“…6 According to the literature review, PMV in subjects subject to CABG can be defined by different ranges: >12 hours, >24 hours and >48 hours of ventilatory support. 1,7,8 The latter was used for this study. PMV is considered a significant complication following cardiovascular surgery; even though its incidence levels are low, ranging from 2.9% to 8.6%, [9][10][11] it is associated with higher morbidity and mortality rates, which is why it is still a relatively common issue.…”