Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable?

Zante, Bjoern; Erdoes, Gabor

doi:10.1053/j.jvca.2019.04.008

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…Univariate regression analysis results were similar to previous studies which examined the risk factors for PMV after cardiac surgery, i.e., age, CPB time (14), preoperative creatinine, preoperative EF (15), lactate at admission and a high dose of vasopressors (16).…”

Section: Discussionsupporting

confidence: 81%

Elevated pulsatility index of the superior mesenteric artery indicated prolonged mechanical ventilation in patients after cardiac valve surgery

Zhou

Cui

et al. 2023

Front. Surg.

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PurposeThis study examined whether alterations in Doppler parameters of superior mesenteric artery (SMA) are associated with prolonged mechanical ventilation (PMV) in patients who underwent cardiac valve surgery.MethodsHemodynamic and SMA Doppler parameters were collected at intensive care unit(ICU) admission. The duration of mechanical ventilation was monitored. PMV was defined as mechanical ventilation ≥96 h.ResultsA total of 132 patients admitted to ICU after cardiac valve surgery were evaluated for enrollment, of whom 105 were included. Patients were assigned to the control (n = 63) and PMV (n = 42) groups according to the mechanical ventilation duration. The pulsatility index(SMA-PI) and resistive index of SMA (SMA-RI) were 3.97 ± 0.77 and 0.88 (0.84–0.90) in the PMV group after cardiac valve surgery, which was lower than the SMA-PI (2.95 ± 0.71, p < 0.0001) and SMA-RI of controls (0.8, 0.77–0.88, p < 0.0001). SMA-PI at admission had favorable prognostic significance for PMV (AUC = 0.837, p < 0.0001).ConclusionsAn elevated SMA-PI is common in patients after cardiac valve surgery with PMV. Increased SMA-PI could help predict PMV after cardiac valve surgery. Using point-of-care ultrasound to measure SMA-PI at ICU admission is an acceptable and reproducible method for identifying patients with PMV.

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Section: Discussionsupporting

confidence: 81%

Elevated pulsatility index of the superior mesenteric artery indicated prolonged mechanical ventilation in patients after cardiac valve surgery

Zhou

Cui

et al. 2023

Front. Surg.

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“…The cumulative effect of various factors on patient physiology eventually influences early ICU interventions ( 34 ). In essence, intraoperative procedures may directly or indirectly contribute to the prolonged postoperative intubation duration ( 35 , 36 ). Regrettably, existing predictive models for postoperative cardiac PI yield suboptimal results.…”

Section: Discussionmentioning

confidence: 99%

“…Building upon this, Sharma et al employed a significantly larger sample size of cardiac surgical patients (32,045) to develop prediction models for prolonged ventilation following CS, achieving an AUROC of 0.787 ( 38 ). This may be attributed to limitations in the sample size and the intricate physiological changes during prolonged surgery under cardiopulmonary bypass ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Linking preoperative and early intensive care unit data for prolonged intubation prediction

Wang,

Zhu,

Liu

et al. 2024

Front. Cardiovasc. Med.

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ObjectivesProlonged intubation (PI) is a frequently encountered severe complication among patients following cardiac surgery (CS). Solely concentrating on preoperative data, devoid of sufficient consideration for the ongoing impact of surgical, anesthetic, and cardiopulmonary bypass procedures on subsequent respiratory system function, could potentially compromise the predictive accuracy of disease prognosis. In response to this challenge, we formulated and externally validated an intelligible prediction model tailored for CS patients, leveraging both preoperative information and early intensive care unit (ICU) data to facilitate early prophylaxis for PI.MethodsWe conducted a retrospective cohort study, analyzing adult patients who underwent CS and utilizing data from two publicly available ICU databases, namely, the Medical Information Mart for Intensive Care and the eICU Collaborative Research Database. PI was defined as necessitating intubation for over 24 h. The predictive model was constructed using multivariable logistic regression. External validation of the model's predictive performance was conducted, and the findings were elucidated through visualization techniques.ResultsThe incidence rates of PI in the training, testing, and external validation cohorts were 11.8%, 12.1%, and 17.5%, respectively. We identified 11 predictive factors associated with PI following CS: plateau pressure [odds ratio (OR), 1.133; 95% confidence interval (CI), 1.111–1.157], lactate level (OR, 1.131; 95% CI, 1.067–1.2), Charlson Comorbidity Index (OR, 1.166; 95% CI, 1.115–1.219), Sequential Organ Failure Assessment score (OR, 1.096; 95% CI, 1.061–1.132), central venous pressure (OR, 1.052; 95% CI, 1.033–1.073), anion gap (OR, 1.075; 95% CI, 1.043–1.107), positive end-expiratory pressure (OR, 1.087; 95% CI, 1.047–1.129), vasopressor usage (OR, 1.521; 95% CI, 1.23–1.879), Visual Analog Scale score (OR, 0.928; 95% CI, 0.893–0.964), pH value (OR, 0.757; 95% CI, 0.629–0.913), and blood urea nitrogen level (OR, 1.011; 95% CI, 1.003–1.02). The model exhibited an area under the receiver operating characteristic curve (AUROC) of 0.853 (95% CI, 0.840–0.865) in the training cohort, 0.867 (95% CI, 0.853–0.882) in the testing cohort, and 0.704 (95% CI, 0.679–0.727) in the external validation cohort.ConclusionsThrough multicenter internal and external validation, our model, which integrates early ICU data and preoperative information, exhibited outstanding discriminative capability. This integration allows for the accurate assessment of PI risk in the initial phases following CS, facilitating timely interventions to mitigate adverse outcomes.

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“…The primary outcome was PMV. The non‐PMV group referred to patients intubated either in the operating theater or <24 h after operation, while the PMV group included patients receiving mechanical ventilation ≥24 h after cardiac surgery 11,12 . Secondary outcomes included poor prognosis and prolonged PICU and hospital stay.…”

Section: Methodsmentioning

confidence: 99%

“…The non-PMV group referred to patients intubated either in the operating theater or <24 h after operation, while the PMV group included patients receiving mechanical ventilation ≥24 h after cardiac surgery. 11,12 Secondary outcomes included poor prognosis and prolonged PICU and hospital stay. Due to the low expected mortality, using a dichotomous poor prognosis variable (defined as the occurrence of any one of the following events or interventions: delayed sternal closure, extracorporeal membrane oxygenation, peritoneal dialysis, permanent pacemaker implantation, debridement, secondary operation, pericardiotomy, and death), we decided to evaluate the outcome by dichotomizing the LOS in the hospital by the median (10 days) in the entire cohort.…”

Section: Endpointsmentioning

confidence: 99%

Vasoactive‐inotropic score/inotropic score and short‐term outcomes in pediatrics undergoing cardiac surgery: A retrospective analysis from single center

Sun

Yao

2022

Journal of Cardiac Surgery

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Background and Aim of the Study This study aimed to investigate the association between vasoactive‐inotropic score/inotropic score (VIS/IS) and short‐term outcomes in pediatric patients after cardiac surgery at a tertiary care center in an unselected pediatric population in China. Methods This study carried out retrospective observation of 401 patients between April and June 2021 at a tertiary care center. VIS and IS were assessed intraoperatively (VIS‐op, IS‐op) and 2 h (VIS2h, IS2h), 24 h (VIS24h, IS24h), and 48 h (VIS48h, IS48h) postoperatively. The primary outcome was prolonged mechanical ventilation (PMV). Secondary outcomes included poor prognosis and length of stay in the pediatric intensive care unit and hospital. Results Mean age of the included pediatric patients was 26.5 months. Pediatric cardiac procedures were performed within an average operation duration of 167.6 ± 70.8 min. Overall, the PMV group (n = 93) experienced significantly longer ACC duration, cardiopulmonary bypass duration, operation duration, and a higher prevalence of fluid accumulation overload than the non‐PMV group (n = 93). Multivariate logistic regression analysis revealed that longer operation duration (odds ratio [OR]: 1.015; 95% confidence interval [95% CI]: 1.003, 1.026; p = .012) and higher VIS48h (OR: 1.188; 95% CI: 1.077, 1.311; p = .001) were strongest predictors for PMV. VIS48h had better discrimination power for PMV than other time intervals, and the area under the curve was 0.780 (95% CI, 0.721, 0.839; p = .000). Conclusions VIS48h independently predicted short‐term outcomes after cardiac surgery in an unselected pediatric population in China and showed better prediction accuracy and discrimination capability than other time intervals.

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Risk of Prolonged Mechanical Ventilation After Cardiac Surgery: Predicting the Unpredictable?

Cited by 5 publications

References 10 publications

Elevated pulsatility index of the superior mesenteric artery indicated prolonged mechanical ventilation in patients after cardiac valve surgery

Elevated pulsatility index of the superior mesenteric artery indicated prolonged mechanical ventilation in patients after cardiac valve surgery

Linking preoperative and early intensive care unit data for prolonged intubation prediction

Vasoactive‐inotropic score/inotropic score and short‐term outcomes in pediatrics undergoing cardiac surgery: A retrospective analysis from single center

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