Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery

Gilliland, Samuel; Brainard, Jason

doi:10.1177/1089253215572699

Cited by 11 publications

(7 citation statements)

References 45 publications

(52 reference statements)

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“…Another study also reported different predictors for postoperative respiratory failure that included pneumonia, prolonged intubation >48 hours and reintubation; age >65 years, preoperative CHF, preoperative arterial pO2, duration of CPB, phrenic nerve injury and postoperative AKI were independent risk predictors . The ability to identify patients at risk of developing CS‐PRF will allow clinicians to provide preventive measures to minimize CS‐PRF such as preoperative pulmonary treatment, advocating smoking cessation, intraoperative ventilation strategies, intensive postoperative assessment for early extubation, postoperative non‐invasive ventilation and postoperative reversal of neuromuscular blocking agents …”

Section: Discussionmentioning

confidence: 99%

Predictors and outcomes of postoperative respiratory failure after cardiac surgery

Thanavaro

Taylor

Vitt

et al. 2019

Evaluation Clinical Practice

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Background: Postoperative respiratory failure after cardiac surgery (CS-PRF) is a devastating complication and its incidence and predictors vary depending on how it is defined and the patient population. Aims: This study was conducted to determine the incidence, predictors and outcomes of CS-PRF defined as prolonged mechanical ventilation >48 hours and reintubation. Methods: This is a retrospective chart review of 1257 patients who underwent cardiac surgery between June 2011 and December 2018. The research questions were addressed through bivariate inferential, descriptive and binary logistic regression. Results: The overall incidence of CS-PRF was 15.9% and significant regression predictors included diabetes mellitus (OR = 1.77, P = .001), preoperative renal replacement therapy (OR = 2.07, P = .033), need for intraoperative transfusion (OR = 2.35, P = .000), combined coronary bypass/valvular surgery (OR = 2.61, P = .001) and intra-aortic balloon pump (OR = 3.60, P = .000). CS-PRF patients had increased postoperative blood transfusions (69.5% vs 27.

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Section: Discussionmentioning

confidence: 99%

Predictors and outcomes of postoperative respiratory failure after cardiac surgery

Thanavaro

Taylor

Vitt

et al. 2019

Evaluation Clinical Practice

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“…The poor performance of the chest radiography is easily explained by the high incidence of bilateral posterobasal consolidations (94% in our study) in mechanically ventilated patients following cardiac surgery. [32] As previously reported 19 , bilateral radiological in ltrate and coalescent B2 lines due to hydrostatic pulmonary edema were present in 30% of our patients on ECMO VA [33], complicating the chest radiography interpretation. These results support the concept that combining ultrasound and clinical criteria is more discriminating than combining radiological and clinical criteria for the diagnosis of pneumonia in patients on VA ECMO.…”

Section: Components Of Scpis and Lus-scpis: Diagnostic Value In Patients On Va Ecmomentioning

confidence: 53%

Usefulness of Lung Ultrasound for early detection of Hospital-Acquired Pneumonia in Patients on Veno-Arterial Extra Corporeal Membrane Oxygenation.

Pasqueron¹,

Dureau²,

Arcile³

et al. 2021

Preprint

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BACKGROUND: Hospital-Acquired Pneumonia (HAP) is the most common and severe complication in patients treated with veno-arterial extracorporeal membrane oxygenation (ECMO). HAP early detection is challenging but crucial for improving clinical outcomes. We conduct an observational study to assess whether Lung Ultrasound (LUS) improves detection of HAP in in patients treated with veno-arterial ECMO.METHODS: We conducted a single-center, prospective, observational study including adult patients receiving veno-arterial extracorporeal membrane oxygenation assistance that presented acute respiratory failure. Bedside LUS and chest radiography were performed at the time of inclusion when HAP was suspected. Then the patients were independently assessed for HAP including microbiological evidence. The sonographic features of HAP on veno-arterial ECMO were determined. We then compared the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), including bio-clinical data and the Doppler detection of intrapulmonary shunt, to the sCPIS, including bio-clinical and chest radiological data for detection of HAP. RESULTS: We included 70 patients, of which 44 (63%) were independently diagnosed with hospital-acquired pneumonia. LUS examination revealed that Doppler intrapulmonary shunt (P=0.0000043) and dynamic air bronchogram (P=0.00024) were the most frequent hospital-acquired pneumonia-related signs. The LUS-sCPIS (Area under the curve = 0.77) yielded significantly better results than the sCPIS (Area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiology were not discriminating for the hospital-acquired pneumonia diagnosis.CONCLUSION: The diagnosis of hospital-acquired pneumonia is a daily challenge for the clinician managing patients on veno-arterial ECMO . Lung ultrasound is more powerful than chest radiography and can be a valuable aid as initial imaging modality for the diagnosis of pneumonia. Intrapulmonary shunt detected using color Doppler and dynamic air bronchogram appear to be particularly discriminating for the diagnosis of hospital-acquired pneumonia.CLINICAL TRIAL REGSITRATION: NA

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“…The poor performance of the chest radiography is easily explained by the high incidence of bilateral postero-basal consolidations (94% in our study) in mechanically ventilated patients [ 30 ]. As previously reported, bilateral radiological infiltrate and coalescent B lines due to hydrostatic pulmonary edema were present in 30% of our patients on ECMO VA [ 31 ], complicating the chest radiography interpretation.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation

Pasqueron

Dureau

Arcile

et al. 2022

Ann. Intensive Care

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Background Hospital-acquired pneumonia (HAP) is the most common and severe complication in patients treated with venoarterial extracorporeal membrane oxygenation (VA ECMO) and its diagnosis remains challenging. Nothing is known about the usefulness of lung ultrasound (LUS) in early detection of HAP in patients treated with VA ECMO. Also, LUS and chest radiography were performed when HAP was suspected in cardiac critically ill adult VA ECMO presenting with acute respiratory failure. The sonographic features of HAP in VA ECMO patients were determined and we assessed the performance of the lung ultrasound simplified clinical pulmonary score (LUS-sCPIS), the sCPIS and bioclinical parameters or chest radiography alone for early diagnosis of HAP. Results We included 70 patients, of which 44 (63%) were independently diagnosed with HAP. LUS examination revealed that color Doppler intrapulmonary flow (P = 0.0000043) and dynamic air bronchogram (P = 0.00024) were the most frequent HAP-related signs. The LUS-sCPIS (area under the curve = 0.77) yielded significantly better results than the sCPIS (area under the curve = 0.65; P = 0.004), while leukocyte count, temperature and chest radiography were not discriminating for HAP diagnosis. Discussion Diagnosis of HAP is a daily challenge for the clinician managing patients on venoarterial ECMO. Lung ultrasound can be a valuable tool as the initial imaging modality for the diagnosis of pneumonia. Color Doppler intrapulmonary flow and dynamic air bronchogram appear to be particularly insightful for the diagnosis of HAP.

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Postoperative Noninvasive Ventilation Following Cardiothoracic Surgery

Cited by 11 publications

References 45 publications

Predictors and outcomes of postoperative respiratory failure after cardiac surgery

Predictors and outcomes of postoperative respiratory failure after cardiac surgery

Usefulness of Lung Ultrasound for early detection of Hospital-Acquired Pneumonia in Patients on Veno-Arterial Extra Corporeal Membrane Oxygenation.

Usefulness of lung ultrasound for early detection of hospital-acquired pneumonia in cardiac critically ill patients on venoarterial extracorporeal membrane oxygenation

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