Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery

Shirzad, Mahmood; Karimi, Abbas; Ahmadi, Seyed Hossein; Marzban, Mehrab; Tazik, Mokhtar; Aramin, Hermineh

doi:10.4081/monaldi.2010.276

Cited by 13 publications

(18 citation statements)

References 28 publications

(28 reference statements)

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“…This failure rate is higher than that reported in other studies (1), most likely because our study was performed in a cardiac surgery referral center and included severely ill patients, as shown by the high EuroSCOREs (22). The patients who had weaning failure in our study may have developed myocardial dysfunction secondary to CPB.…”

Section: Discussionmentioning

confidence: 54%

“…The failure to wean from mechanical ventilation after cardiac surgery is associated with worse outcomes, including increased length of hospital stays and higher costs (1-3). In a prospective study of 885 patients who underwent coronary artery bypass grafting (CABG), Wong et al (4) identified increased age, female gender, the postoperative use of an intra-aortic balloon pump (IABP), the use of inotropes, bleeding, and atrial arrhythmia as risk factors for weaning failure and prolonged mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

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High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Lara¹,

Hajjar²,

Almeida³

et al. 2013

Clinics

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OBJECTIVE:The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery.METHODS:We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h.RESULTS:Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation.CONCLUSIONS:A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

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Section: Discussionmentioning

confidence: 54%

Section: Introductionmentioning

confidence: 99%

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Lara¹,

Hajjar²,

Almeida³

et al. 2013

Clinics

View full text Add to dashboard Cite

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“…8 Tem sido observado na literatura científica, o predomínio de mulheres idosas com comorbidades variadas, submetidas a cirurgias cardíacas, em especial troca de válvula. [9][10][11] O conhecimento das variavéis sociodemográficas, clínicas e cirúrgicas dos indivíduos submetidos à cirurgia cardíaca são essenciais para o planejamento de qualidade da assistência de enfermagem. 5,[11][12][13] Tendo em vista que diversos destes aspectos podem contribuir para aumentar o tempo de permanência em Unidade de Terapia Intensiva (UTI) e tempo de ventilação mecânica.…”

Section: Discussionunclassified

“…Da mesma forma, a cirurgia cardíaca prévia é um fator independente para VM prolongada, o que resulta em maior tempo de permanência do paciente no leito. [9][10]17 Assim, estudos anteriores realizados com pacientes no pós-operatório de cirurgia cardíaca elencaram diagnósticos iguais aos do presente estudo, entre eles: mobilidade física prejudicada, débito cardíaco diminuído, hipotermia, comunicação verbal prejudicada, risco de integridade da pele prejudicada, risco de queda, risco de aspiração, risco de infecção e integridade tissular prejudicada. 5,18 O diagnóstico Risco de Infecção tem alta prevalência em pacientes submetidos à cirurgia cardíaca, possivelmente, relacionado à necessidade de procedimentos invasivos, como por exemplo: cateterismo vesical, acesso venoso central, drenos de tórax e mediastino, acesso arterial para pressão arterial média, além da destruição dos tecidos e das defesas primárias.…”

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Diagnósticos de enfermagem no pós-operatório imediato de cirurgia de troca de válvula

2017

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RESUMO: Objetivo: identificar os diagnósticos de enfermagem no pós-operatório imediato de cirurgia de troca de válvula. Método: estudo documental, de corte transversal, realizado por meio dos prontuários de pacientes submetidos à cirurgias valvares entre janeiro e dezembro de 2014, em um hospital de grande porte, especializado em cardiologia, do Estado de São Paulo. Resultados: entre os 50 prontuários analisados, 58% pacientes eram do sexo feminino. Foram identificados 11 diagnósticos de enfermagem, sendo 55% classificados com foco no problema e 45% de risco. Os diagnósticos de enfermagem mais prevalentes foram Risco de Infecção (100%), Mobilidade Física Prejudicada (94%) e Risco de Queda (94%). Conclusão: o diagnóstico mais prevalente no pós-operatório imediato de cirurgia foi risco de infecção. Os diagnósticos identificados possibilitaram a compreensão mais adequada da experiência vivenciada pelo paciente e a percepção dos enfermeiros em relação ao processo saúde doença do mesmo, contribuindo para a otimização de recursos humanos e materiais. Descritores: Cirurgia torácica; Anuloplastia da valva cardíaca; Diagnóstico de enfermagem. ABSTRACT: Aim: To identify the nursing diagnoses in the immediate

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“…Prapas et al 11 concluded that periop need IABP insertion is also an independent risk factor of delayed extubation after CABG surgery. According to Shirzadet al 24 atrial fibrillation, sudden cardiac arrest and need for intubation are common risk factors of delayed extubation after valvular heart surgery. So different researchers have found different risk factors of delayed extubation after cardiac surgery.…”

Section: Early Extubation (N=55) Delayed Extubation (N=26) P-valuementioning

confidence: 99%

Cardaic Surgery; Risk Factors of Delayed Extubation

Hashmi

2017

TPMJ

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ABSTRACT… Objectives:To identify the risk factors of delayed extubation after cardiac surgery. Study Design: Observational study. Setting: Cardiac surgery in CPE Institute of Cardiology. Period: 2 months from November-2016 to March-2017. Methods: Eighty-one (81) patients who underwent cardiac surgery. In ICU we recorded extubation time of all patients. Patients with extubation time <6 hours after labelled as early extubation group and those with extubation time >6 hours were labelled as delayed extubation group. We recorded their preoperative risk factors and operative variables of surgery to identify the risk factors that leads to late extubation after cardiac surgery (CS). Results: Prevalence of diabetes was significantly high in patients with delayed extubation. There were 42.3% diabetic patients with delayed extubation and only 12.7% diabetic patients with early extubation (p-value 0.003). Total pump time, cross clamp time and type of operation were similar between the groups. Cardiovascular instability was the most common cause of delayed extubation that occurred in 9 patients, reduced level of consciousness in 9 patients, post-op bleeding in 6 patients, while hypoxemia and increased respiratory rate occurred in 1, 1 patient respectively. Conclusion: Diabetes Mellitus is an independent risk factor of delayed extubation after cardiac surgery. Cardiovascular instability, reduced level of consciousness and post-operative bleeding after surgery are the main factors that leads to delayed extubation after CS.

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Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery

Cited by 13 publications

References 28 publications

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery

Diagnósticos de enfermagem no pós-operatório imediato de cirurgia de troca de válvula

Cardaic Surgery; Risk Factors of Delayed Extubation

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