Predictors of prolonged mechanical ventilation following aorta no-touch off-pump coronary artery bypass surgery

Prapas, Sotirios; Panagiotopoulos, Ιoannis; Abdelsalam, Ashraf; Kotsis, V.; Protogeros, Dimitrios; Linardakis, Ioannis N.; Danou, Fotini N.

doi:10.1016/j.ejcts.2007.05.025

Cited by 26 publications

(22 citation statements)

References 18 publications

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“…6,7 A number of studies regarding PMV following cardiac surgery have examined its predictors or its influence on clinical outcomes and costs. [8][9][10][11][12][13][14][15][16][17] However, little is known about PMV following AAAD surgery. The aim of this retrospective study was to identify predictors of PMV following AAAD surgery and to assess the influence of PMV on the short and long-term postoperative courses.…”

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confidence: 99%

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Kimura

Tanaka

Kawahito

et al. 2008

Circ J

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ompared to the relatively favorable in-hospital outcomes of acute type B aortic dissection, 1,2 acute type A aortic dissection (AAAD) remains one of the most serious cardiovascular diseases associated with a high mortality. The latest report from the International Registry of Acute Aortic Dissection Investigators group indicated that in-hospital mortality remains high (163 of 682 patients (23.9%) with AAAD treated surgically between 1996 and 2003). 3 With such critical illness, some patients require prolonged mechanical ventilation (PMV) after surgery. Compared with patients who undergo other cardiac surgeries, patients with AAAD are more likely to suffer preoperative hemodynamic instability, organ malperfusion, and prolonged cardiopulmonary bypass (CPB) during surgery. In addition, re-exploration for bleeding and neurological deficits are common postoperative complications in these patients. 4 All these factors can contribute to PMV after AAAD surgery. 5 Another factor related to the PMV is systemic inflammatory response-related lung injury evoked by acute aortic dissection. 6,7 A number of studies regarding PMV following cardiac surgery have examined its predictors or its influence on clinical outcomes and costs. [8][9][10][11][12][13][14][15][16][17] However, little is known about PMV following AAAD surgery. The aim of this retrospective study was to identify predictors of PMV following AAAD surgery and to assess the influence of PMV on the short and long-term postoperative courses. MethodsFrom January 1997 through to December 2006, 243 consecutive patients with AAAD underwent emergency surgery at our hospital. Aortic dissection was diagnosed by means of enhanced computed tomography scan or echocardiography, and transesopageal echocardiography was used for confirmation when possible. In all patients, emergency surgery was performed within 14 days after the onset of symptoms; 90% of these surgeries were performed within 48 h. So that we could focus on PMV, 10 patients who died within 48 h after surgery were excluded from the study. Death within 48 h after surgery was due to profound cardiac failure (8 patients) or refractory bleeding (2 patients). The remaining 233 patients (120 men, 113 women, mean age: 63.4±11.2 years) were divided into 2 groups according to the duration of mechanical ventilation: those who were tracheally extubated within 48 h after admission to the intensive care unit (ICU) (group A, n=149) and those who required mechanical ventilation for more than 48 h (group B, n=84). Patients who were reintubated within 24 h after extubation were considered to have an interrupted period of ventilation. To identify the independent predictors for PMV, we compared 48 perioperative factors (25 preoperative factors and 23 intra or postoperative factors) between the 2 groups. Mortality and morbidity, length of the ICU and hospital stays, and long-term survival were compared

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confidence: 99%

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Kimura

Tanaka

Kawahito

et al. 2008

Circ J

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“…[12][13][14] Due to a system of risk factors (such as the duration of surgery, anesthesia, clinical condition, mode of ventilator therapy, and method of weaning from mechanical ventilation), many patients should receive prolonged mechanical ventilation. [15][16][17] It was reported that the prolonged mechanical ventilation could prolong the hospital and intensive care unit (ICU) stay, 18) increase the burden of patients, and raise the risk of cerebral palsy, postoperative atrial fibrillation or ventilator-associated pneumonia.19-21) Thus, it is necessary to reduce the duration of mechanical ventilation in patients requiring prolonged mechanical ventilation.A previous study has showed that early rehabilitation therapy in ICU after CABG could significantly improve the outcomes of patients with less than 72 hours of mechanical ventilation.22) However, it is still unknown whether early rehabilitation therapy could improve the clinical outcomes and reduce the duration of mechanical ventilation in patients requiring over 72 hours of mechanical ventilation after CABG. Thus, we performed this study to evaluate the influence of early rehaFrom the…”

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confidence: 99%

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Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Dong

Zhang

et al. 2016

Int. Heart J.

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SummaryWe investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P < 0.01), hospital stay (early rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P < 0.01) for patients requiring more than 72 hours prolonged mechanical ventilation. The results of Kaplan-Meier analysis showed that the proportions of patients remaining on mechanical ventilation in the early rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P < 0.01).The results provide evidence for supporting the application of early rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG. (Int Heart J 2016; 57: 241-246) Key words: Postoperative recovery, Hospital stay, Randomized controlled trial, Intensive care unit C oronary artery disease is the primary cause of death worldwide. 1) Coronary artery bypass surgery (CABG) is commonly used for patients with severe coronary artery disease at the left anterior descending artery, circumflex artery, and right coronary artery.2,3) Cardiac rehabilitation is used for improving functional capacity and reducing cardiovascular mortality and morbidity in patients undergoing CABG. [4][5][6] Previous studies have shown that rehabilitation therapy could significantly reduce the length of hospitalization time, costs and complications, promote cardiac function recovery, and improve the quality of life in patients who underwent CABG. [7][8][9][10][11] Mechanical ventilation was routinely applied after CABG to reduce the power consumption of the respiratory system and the cardiac burden to improve postoperative cardiac recovery. [12][13][14] Due to a system of risk factors (such as the duration of surgery, anesthesia, clinical condition, mode of ventilator therapy, and method of weaning from mechanical ventilation), many patients should receive prolonged mechanical ventilation. [15][16][17] It was reported that the prolonged mechanical ventilation could prolong the hospital and intensive care unit (ICU) stay, 18) incre...

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“…Some studies, on the other hand have found older age as a risk factor of delayed extubation and these studies have found age >65 year is a risk factor of delayed extubation after surgery. 11,12 According to Suematsu et al risk of delayed extubation is increased in patients with age >70 Years. 3 In our study, there was no effect of female gender on delayed extubation.…”

Section: Discussionmentioning

confidence: 99%

“…22 Dunning et al 23 found that left ventricular systolic dysfunction and urgency of the procedure as independent risk factors of prolonged ventilation after surgery. 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.…”

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 of prolonged mechanical ventilation following aorta no-touch off-pump coronary artery bypass surgery

Abstract: In this study, PMV following aorta no-touch OPCAB was related to preoperative variables: age, octogenarians, preoperative IABP, TIA, and stroke. There was no relation between PMV and any of the operative data.

Cited by 26 publications

References 18 publications

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery

Cardaic Surgery; Risk Factors of Delayed Extubation

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