Nosocomial Infections and Balloon Counterpulsation: Risk Factors and Outcome

Abstract

Between February and September 2003, 136 (5.3%) of 2,558 patients undergoing cardiac surgery were supported with intra-aortic balloon counterpulsation. There were 71 infected (group 1) and 65 noninfected (group 2) patients. Risk factors for nosocomial infections were identified by univariate and multivariate analysis. On univariate analysis, significant risk factors were operation time, balloon pump duration, ventilation hours, duration of central venous catheter placement, amount of blood transfused, left ventricular ejection fraction<30%, intra- and/or postoperative intra-aortic balloon counterpulsation, surgery under cardiopulmonary bypass, combined procedures, re-exploration, and Acute Physiology And Chronic Health Evaluation (APACHE) II score. On multivariate analysis, ventilation hours and amount of blood transfused were independently associated with group 1. Respiratory tract infections were common in the balloon counterpulsation population (41.1%). Mortality was significantly higher in patients needing balloon pump support (19.9%) compared to controls (1.1%), but it was similar in groups 1 and 2. Recognition of risk factors for postoperative infection in patients undergoing cardiovascular surgical procedures with intra-aortic balloon counterpulsation may help to improve their prognosis and allow more organized surveillance.

The influence of intra-aortic balloon counter pulsation on central venous blood oxygen saturation

“…Similarly, Pawar et al found that the balloon was a risk factor for nosocomial infections in univariate analysis. 35…”

In which conditions should we insert an intra-aortic balloon pump? In the operating room or intensive care unit?

“…[10,11] In the studies by Beckman et al [12] and McCabe et al [13] evaluating the complications of IABP, the incidence of local wound site infection was found to be 2.2 to 5%. In a study by Pawar et al [18] including 136 patients with IABPs inserted, the most common systemic infection resulted from the respiratory system and this was attributed to the increased incidence of atelectasis and superinfection in patients who were unable to be mobilized while under the support of IABP. In another study by Goldberg et al [19] with 101 patients comparing percutaneous and surgical techniques, the rates of local (2%) and systemic (4%) infections were found to be higher in patients undergoing the surgical method.…”