Impact of Tracheostomy Timing on Outcomes After Cardiovascular Surgery

Okada, Minoru; Watanuki, Hirotaka; Tochii, Masato; Sugiyama, Kayo; Futamura, Yasuhiro; Matsuyama, Katsuhiko

doi:10.1053/j.jvca.2021.10.001

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…Undergoing a tracheostomy is an important indicator of the increased risk of poor prognoses in patients undergoing cardiovascular surgeries [ 3 , 7 , 9 , 20 ], which was again confirmed in the current study. Due to the difference of surgical populations in different studies, the reported rates of POTs in the previous literature were quite different [ 3 , 7 , 8 , 9 , 10 , 11 ].…”

Section: Discussionsupporting

confidence: 82%

“…Numerous studies have been conducted on POTs after various surgical procedures due to the adverse outcomes, and the risk factors identified in our analysis have also been reported in different reports [ 3 , 4 , 5 , 19 , 20 , 21 , 22 ]. Being of an older age was identified to associate with a higher risk of POTs in the current study; however, the results of whether the risk of POTs would increase with age were inconsistent in previous studies, which may be due to the difference in disease types and study populations [ 4 , 22 , 23 ].…”

Section: Discussionsupporting

confidence: 67%

“…In some major operations, such as liver transplantation and heart surgery, patients requiring a tracheostomy have a significantly longer hospital stay and lower overall survival rate compared with patients who do not require a tracheostomy [ 4 , 10 ]. Several studies focused on POTs have been conducted in patients undergoing cardiovascular surgery due to the high prevalence and significantly poorer outcomes [ 3 , 5 , 10 , 19 , 20 ]. Some significant risk factors for POTs have been reported and several predictive systems have been established in previous studies [ 4 , 5 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery

Ding

Sun

Liu

et al. 2023

JCDD

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Postoperative tracheostomy (POT) is an important indicator of critical illness, associated with poorer prognoses and increased medical burdens. However, studies on POTs after heart valve surgery (HVS) have not been reported. The objectives of this study were first to identify the risk factors and develop a risk prediction model for POTs after HVS, and second to clarify the relationship between POTs and clinical outcomes. Consecutive adults undergoing HVS from January 2016 to December 2019 in a single cardiovascular center were enrolled, and a POT was performed in 1.8% of the included patients (68/3853). Compared to patients without POTs, the patients with POTs had higher rates of readmission to the ICU and in-hospital mortality, as well as longer ICU and hospital stays. Five factors were identified to be significantly associated with POTs after HVS by our multivariate analysis, including age, diabetes mellitus, pulmonary edema, intraoperative transfusion of red blood cells, and surgical types. A nomogram and a risk calculator were constructed based on the five factors, showing excellent discrimination, calibration, and clinical utility. Three risk intervals were defined as low-, medium-, and high-risk groups according to the nomogram and clinical practice. The findings of this study may be helpful for early risk assessment and perioperative management.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nomogram and Risk Calculator for Postoperative Tracheostomy after Heart Valve Surgery

Ding

Sun

Liu

et al. 2023

JCDD

View full text Add to dashboard Cite

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“…However, robust evidence of these benefits is scarce. The best timing and technique for tracheostomy after cardiac surgery are still debated as well [ 65 , 66 , 67 , 68 , 69 ].…”

Section: Prolonged Ventilation and Tracheostomymentioning

confidence: 99%

“…The optimal timing for tracheostomy after cardiac surgery is also a matter of debate. Okada et al, in a retrospective, observational study, found that early tracheostomy (i.e., within seven days from ICU admission) was associated with better clinical outcomes, with lower mortality and morbidity rates [ 68 ]. In another retrospective observational study, Affronti et al found that early tracheostomy (i.e., within 14 days after surgery) in patients undergoing cardiac surgery was associated with a shorter ventilation time and ICU and hospital length of stay but did not result in a lower in-hospital and long-term mortality rate [ 69 ].…”

Section: Prolonged Ventilation and Tracheostomymentioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.

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