Predictors of Postoperative Mechanical Ventilation Time , Length of ICU Stay and Hospitalization Period after Cardiac Surgery in Adults

Altaani, Haitham; aladwan, Hayel; Moh'd, Ashraf Fadel; Qsous, Rami; Khasawneh, Mohammad A.; Abu-Jubbah, Rani

doi:10.12816/0018548

Cited by 2 publications

(1 citation statement)

References 19 publications

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“…Factors such as morbid obesity (BMI >40 kg/m 2 ), advanced age, and males were associated with prolonged IMV in post cardiac surgery patients [10–12]. Other factors associated with increased incidence of acute lung injury in sepsis include elevated lactate, delayed antibiotics, alcohol abuse, and diabetes mellitus [13,14].…”

Section: Discussionmentioning

confidence: 99%

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Dhital

Basnet

Poudel

2018

Journal of Community Hospital Internal Medicine Perspectives

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Background: Sepsis is a significant cause of mechanical ventilation in hospitalized patients.Objective: The aim of our study was to recognize the demographic and clinical characteristics associated with an increased need for invasive mechanical ventilation in hospitalized sepsis patients.Methods: We used National Inpatient Sample database from the years 2009–2011 to identify sepsis patients requiring invasive mechanical ventilation. We compared demographic and clinical characteristics of sepsis patients requiring and not requiring ventilator support and conducted univariate and multivariate analyses to determine odds ratio (OR) of association.Results: A total of 4,827,769 sepsis patients were identified among which 21.38% required invasive ventilation. Multivariate logistic regression [OR (95% CI), p<0.001] determined the following to be associated with increased odds of ventilator use: morbid obesity [1.37 (1.31–1.42)] and age group 35-64 years [1.18 (1.14–1.22)] compared to 18–34 years, whereas females [0.90 (0.88–0.91)] and age >85 years [0.49 (0.47–0.52)] had reduced odds of invasive ventilation. Hyperkalemia [1.12 (1.09–1.16)] and hypernatremia [2.26 (2.16–2.36)] were associated with increased odds while hypokalemia [0.94 (0.91–0.97)] had reduced odds of invasive ventilation. Septic patients requiring IMV had higher length of stay by 9.72 ± 0.17 days, hospitalization cost by US $ 43010.31 ± 988.24 and in-hospital mortality (41.33% vs 8.91%). Conclusion: Sepsis is a major cause of intensive care unit admission and initiation of invasive ventilation. Baseline demographic and clinical features affect the need for invasive ventilation. A clear understanding of these risk factors is integral for an appropriate and timely management.

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Section: Discussionmentioning

confidence: 99%

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Dhital

Basnet

Poudel

2018

Journal of Community Hospital Internal Medicine Perspectives

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Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

et al. 2018

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BackgroundThe use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery.MethodsThis clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients’ depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented.ResultsDemographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001).ConclusionsCombined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients.

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Predictors of Postoperative Mechanical Ventilation Time , Length of ICU Stay and Hospitalization Period after Cardiac Surgery in Adults

Cited by 2 publications

References 19 publications

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Predictors and outcome of invasive mechanical ventilation in hospitalized patients with sepsis: data from National Inpatient Sample

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial

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