The Effects of Escalation of Respiratory Support and Prolonged Invasive Ventilation on Outcomes of Cardiac Surgical Patients: A Retrospective Cohort Study

Zochios, Vasileios; Chandan, Joht Singh; Schultz, Marcus J.; Morris, Andrew Conway; Parhar, Ken Kuljit S.; Giménez-Milà, Marc; Gerrard, Caroline; Vuylsteke, Alain; Klein, A. A.

doi:10.1053/j.jvca.2019.10.052

Cited by 10 publications

(4 citation statements)

References 39 publications

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“…In the recent retrospective study covering over 900 cardiac surgery patients, it was concluded that early TT (<7 days) may provide better clinical outcomes, with lower mortality and morbidity rates [22]. A research group led by A. Vuylsteke reported longer mechanical ventilation time and higher complication rates with delayed strategy in cardiothoracic ICU patients [23].…”

Section: Discussionmentioning

confidence: 99%

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Załęska-Kocięcka,

Morosin,

Dutton

et al. 2024

Diagnostics

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Advanced respiratory failure with tracheostomy requirement is common in heart recipients. The aim of the study is to assess the tracheostomy rate after orthotopic heart transplantation and identify the subgroups of patients with the highest need for tracheostomy and these groups’ association with mortality at a single centre through a retrospective analysis of 140 consecutive patients transplanted between December 2012 and July 2018. As many as 28.6% heart recipients suffered from advanced respiratory failure with a need for tracheostomy that was performed after a median time of 11.5 days post-transplant. Tracheostomy was associated with a history of stroke (OR 3.4; 95% CI) 1.32–8.86; p = 0.012), previous sternotomy (OR 2.5; 95% CI 1.18–5.32; p = 0.017), longer cardiopulmonary bypass time (OR 1.01; 95% CI 1.00–1.01; p = 0.007) as well as primary graft failure (OR 6.79; 95% CI2.93–15.71; p < 0.001), need of renal replacement therapy (OR 19.2; 95% 2.53–146; p = 0.004) and daily mean SOFA score up to 72 h (OR 1.50; 95% 1.23–1.71; p < 0.01). One-year mortality was significantly higher in patients requiring a tracheostomy vs. those not requiring one during their hospital stay (50% vs. 16%, p < 0.001). The need for tracheostomy in heart transplant recipients was 30% in our study. Advanced respiratory failure was associated with over 3-fold greater 1-year mortality. Thus, tracheostomy placement may be regarded as a marker of unfavourable prognosis.

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Section: Discussionmentioning

confidence: 99%

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Załęska-Kocięcka,

Morosin,

Dutton

et al. 2024

Diagnostics

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“…Zochios V et al in their study found that hypoxemia and anemia on admission to ICU were the only 2 factors independently associated with the need for escalation of respiratory support or prolonged invasive ventilation. Escalation of respiratory support or prolonged invasive ventilation is frequently seen in cardiac surgery patients and is highly associated with increased mortality and morbidity ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?

Štraus¹,

Karabdic²,

Grabovica³

et al. 2023

Acta Inform Med

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Background: Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality. Objective: The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Methods: Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data. Results: Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference. Conclusion: Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient’s recovery and increase the cost of treatment.

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“…Prolonged ventilatory support and delayed endotracheal extubation are associated with an increase in the length of ICU and hospital stay, adverse clinical outcomes, including an increase in mortality, and higher health care costs. 1,2 Previous studies found that post cardiac surgery patients with stable hemodynamics could be safely extubated within 4-6 hours after surgery. 3,4 In order to reduce variations in practice and to avoid delayed extubation, a team comprising postoperative ICU nurses, a cardiovascular-thoracic surgeon, and a cardiovascular anesthesiologist was formed to establish a protocol for ventilator weaning and extubation for postoperative cardiac surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes and Cost of Ventilator Weaning and Endotracheal Extubation Guided by An Established Ventilator Weaning Protocol in Patients Undergoing Elective Cardiac Surgery

et al. 2021

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Objective: To compare successful early extubation rates, complications, and cost before and after the use of anestablished ventilator weaning protocol in patients undergoing elective cardiac surgery.Materials and Methods: Subjects were adult patients undergoing elective cardiac surgery who were clinically stablewithin 2 hours after surgery. The control group underwent conventional ventilator weaning at the discretion of theirattending staff. The intervention group underwent protocol-guided ventilator weaning. The primary outcome wasa successful early extubation (within 6 hours after surgery). Secondary outcomes were complications from weaningto 24 hours after surgery, and the relevant cost related to respiratory and cardiovascular care within 24 hours afteradmission to the postoperative intensive care unit.Results: The primary outcome occurred in 37 out of 65 patients (56.9%) in the intervention group and in 5 out of65 patients (7.7%) in the control group (adjusted odds ratio 20.6; 95% confidence interval 6.7–62.9, p<0.001). Thecomplication rates were not statistically different between the intervention and control groups (26.2% vs. 20.0%,p=0.41). The relevant cost, approximated by the service charges, related to respiratory and cardiovascular care wassignificantly less in the intervention group than in the control group (median 2,491 vs. 2,711 Thai baht, p<0.001).Conclusion: The use of the established ventilator weaning protocol after elective cardiac surgery was associated witha higher rate of successful early extubation and lower cost related to respiratory and cardiovascular care comparedto the conventional practices of ventilator weaning and extubation. The rates of overall complications were notsignificantly different.

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The Effects of Escalation of Respiratory Support and Prolonged Invasive Ventilation on Outcomes of Cardiac Surgical Patients: A Retrospective Cohort Study

Cited by 10 publications

References 39 publications

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

Advanced Respiratory Failure Requiring Tracheostomy—A Marker of Unfavourable Prognosis after Heart Transplantation

How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?

Clinical Outcomes and Cost of Ventilator Weaning and Endotracheal Extubation Guided by An Established Ventilator Weaning Protocol in Patients Undergoing Elective Cardiac Surgery

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