Risk factors for endotracheal re-intubation following coronary artery bypass grafting

Abstract

BackgroundEndotracheal re-intubation following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for re-intubation following CABG. This study aimed to evaluate the independent risk factors for re-intubation following CABG.MethodsThe pre-, intra-, and post-operative materials in patients who had selective and isolated CABG performed on them from January 2004 to July 2012 in our hospital were analyzed retrospectively. Unvariate analysis and logistic regression were used to analyze the risk factor of postoperative re-intubation following CABG.ResultsAmong the 1,244 patients investigated, 97 cases suffered from postoperative re-intubation, and the incidence rate of postoperative re-intubation was 7.8%. The in-hospital mortality in the re-intubation group was significantly higher than that in the non-re-intubation group (9.3% versus 1.4%, P = 0.004). Re-intubation also correlated with many negative outcomes such as pneumonia, tracheotomy, acute renal failure, infection of incision, prolonged mechanical ventilation time, prolonged intensive care unit (ICU) stay and prolonged hospital stay. The most commonly cause of re-intubation after CABG was hypoxemia due to cardiogenic and noncardiogenic disease, which accounted for 72.2%. The relative factors of postoperative re-intubation were tested through unvariate analysis and logistic regression, and the associated factors were obtained. The associated factors for re-intubation following CABG included preoperative chronic obstructive pulmonary disease (COPD) (OR = 2.134, 95% CI = 1.472-2.967), preoperative congestive heart failure (CHF) (OR = 2.325, 95% CI = 1.512-3.121), postoperative relative hypoxemia (OR = 2.743, 95% CI = 1.657-3.326), postoperative acute kidney injury (AKI) (OR = 2.976, 95% CI = 2.127-4.023), postoperative total mechanical ventilation time (OR = 1.976, 95% CI = 1.347-2.645).ConclusionPreoperative COPD, preoperative CHF, postoperative relative hypoxemia, postoperative AKI and postoperative total mechanical ventilation time were five independent risk factors for re-intubation following CABG.

Preventive and therapeutic noninvasive ventilation in cardiovascular surgery

“…Jian et al [16] retrospectively analyzed their data about reintubation for ARF after coronary artery bypass grafting (CABG) over an 8-year period. The incidence of reintubation was 7.8%; reintubation occurred most commonly on the second day after extubation; cardiogenic pulmonary edema and hypoxemia due to pulmonary disease (particularly atelectasis) were the most common causes.…”

High postoperative portal venous flow pulsatility indicates right ventricular dysfunction and predicts complications in cardiac surgery patients

“…Similar findings have been described for the left ventricle, with the maximal incidence of pulmonary oedema leading to reintubation occurring on postoperative day 2. 31 Elevated venous pressures could increase the risk of surgical site bleeding. 32 This would contribute to the strong association between portal flow pulsatility after CPB separation with bleeding and reintervention.…”

Establishing failure predictors for the planned extubation of overweight and obese patients

“…A recent study [ 29 ] on surgical ICUs reported that an elevated BUN level (> 8.2 mmol/L) was an independent risk factor for reintubation (OR: 3.66; 95% CI: 1.97–6.80) in patients with a median BMI of 26.9 (no reintubation group; n = 699) and with a median BMI of 26.2 (reintubation group; n = 65). Another study [ 30 ] reported that acute kidney injury (OR: 2.98; 95% CI: 2.13–4.02) was associated with reintubation after coronary artery bypass grafting surgery. Overall, renal failure can be a risk factor of extubation failure in overweight patients and other populations.…”