Outcomes and predictors of prolonged ventilation in patients undergoing elective coronary surgery

Abstract

OBJECTIVES Despite the seriousness of prolonged mechanical ventilation (PMV) as a postoperative complication, previously proposed risk prediction models were met with limited success. The purpose of this study was to identify perioperative variables associated with PMV in elective primary coronary bypass surgery. PMV was defined as the need for intubation and mechanical ventilation for >72 h, after completion of the operation. METHODS Between April 1997 and September 2010, 10 ,977 consecutive patients were retrospectively reviewed. A series of two multivariate logistic regression analyses were carried out to identify preoperative predictors of prolonged ventilation and the impact of operative variables. RESULTS PMV occurred in 215 (1.96%) patients; 119 (55.3%) of these underwent tracheostomy. At multivariate analysis, predictors included NYHA higher than class II (odds ratio [OR], 1.77; 95% confidence intervals [CI], 1.34-2.34), renal dialysis (OR, 5.5; 95% CI, 2.08-14.65), age at operation (OR, 1.04; 95% CI, 1.02-1.06), reduced FEV(1) (OR, 0.99; 95% CI, 0.98-0.99), body mass index >35 kg/m(2) (OR, 1.73; 95% CI, 1.14-2.63). On serial logistic regression analyses, operative variables added little to the discriminatory power of the model. Kaplan-Meier survival curves showed reduced survival among PMV patients (P < 0.001) with an improved survival in the tracheostomy subgroup. CONCLUSIONS PMV after coronary bypass is associated with a reduction in early and mid-term survival. Risk modelling for PMV remains problematic even when examining a more homogenous lower risk group.

Prolonged Mechanical Ventilation After CABG: Risk Factor Analysis

“…Compared with the numerous studies on this subject, [1][2][3]29 the patient number may seem low to make many inferences from this study. However, the authors believe that the analysis of a tertiary teaching hospital with a high proportion of PMV patients with cardiac etiology may be interesting to others.…”

“…Based on the previous reports, lower early and midterm survival are apparent in patients with PMV. 2,3 The aforementioned studies reported series of patients with high pulmonary risk in PMV. However, there still may be a significant number of patients who require PMV due to cardiac causes.…”

Obesity is still a risk factor in coronary artery bypass surgery

“…Obesity has been suggested as an important risk factor in cardiac surgery, but in recent years acceptable results have been documented which indicated the influence of the improvements in this field. Yet, there is still controversy (2,3).…”

Does Obesity Affect Early Results after Coronary Artery Bypass Grafting?

“…The data on the prolonged mechanical ventilation in obese patients are conflicting. Saleh et al [29] studied the risk factors of prolonged ventilation in patients undergoing CABG and they found that BMI > 35 kg/m 2 was a predictor of prolonged respiratory support. Similar results were observed by Gurbuz et al [8].…”