Tracheostomy in Patients Requiring Prolonged Mechanical Ventilation After Cardiac Surgery

Litton, Edward; Law, Timothy; Stamp, Nikki

doi:10.1053/j.jvca.2018.07.014

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…Tracheostomy may improve comfort and reduce the need for sedation and analgesia in patients who require prolonged mechanical ventilation in the ICU compared with translaryngeal airway access and can also provide more favorable conditions for the weaning of mechanical ventilation (9). In our study population who underwent cardiac surgery, the overall incidence of POT was 2.4%, which was within the range of the results in previous studies (10,11).…”

Section: Discussionsupporting

confidence: 77%

A Predictive Scoring Model for Postoperative Tracheostomy in Patients Who Underwent Cardiac Surgery

Wang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundA subset of patients require a tracheostomy as respiratory support in a severe state after cardiac surgery. There are limited data to assess the predictors for requiring postoperative tracheostomy (POT) in cardiac surgical patients.MethodsThe records of adult patients who underwent cardiac surgery from 2016 to 2019 at our institution were reviewed. Univariable analysis was used to assess the possible risk factors for POT. Then multivariable logistic regression analysis was performed to identify independent predictors. A predictive scoring model was established with predictor assigned scores derived from each regression coefficient divided by the smallest one. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and calibration of the risk score, respectively.ResultsA total of 5,323 cardiac surgical patients were included, with 128 (2.4%) patients treated with tracheostomy after cardiac surgery. Patients with POT had a higher frequency of readmission to the intensive care unit (ICU), longer stay, and higher mortality (p < 0.001). Mixed valve surgery and coronary artery bypass grafting (CABG), aortic surgery, renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease (COPD), pulmonary edema, age >60 years, and emergent surgery were independent predictors. A 9-point risk score was generated based on the multivariable model, showing good discrimination [the concordance index (c-index): 0.837] and was well-calibrated.ConclusionsWe established and verified a predictive scoring model for POT in patients who underwent cardiac surgery. The scoring model was conducive to risk stratification and may provide meaningful information for clinical decision-making.

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Section: Discussionsupporting

confidence: 77%

A Predictive Scoring Model for Postoperative Tracheostomy in Patients Who Underwent Cardiac Surgery

Wang

et al. 2022

Front. Cardiovasc. Med.

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“…The benefits of POT may be improved by the optimal timing of it for cardiac surgical patients, whereas this optimal time point is still unclear and controversial [4,40]. Nonetheless, our study found that the relationship between needing POT and poor outcomes was still significant after limiting any influence of selection bias and the heterogeneity in preoperative variables and surgical extent.…”

Section: Discussionmentioning

confidence: 61%

“…About 28.9%-34.6% of patients with AADS had prolonged mechanical ventilation postoperatively, which was associated with an increased risk of morbidity and mortality [2,3]. Tracheostomy is commonly used for patients requiring prolonged mechanical ventilation in the intensive care unit (ICU) to optimize the work of breathing or facilitate weaning [4]. Some studies reported the number of patients undergoing tracheostomy after AADS and the incidence was about 4.7% to 11.8% [2,5,6].…”

Section: Introductionmentioning

confidence: 99%

Predictors and outcomes of postoperative tracheostomy in patients undergoing acute type A aortic dissection surgery

Wang

Song

et al. 2022

BMC Cardiovasc Disord

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Background Despite surgical advances, acute type A aortic dissection remains a life-threatening disease with high mortality and morbidity. Tracheostomy is usually used for patients who need prolonged mechanical ventilation in the intensive care unit (ICU). However, data on the risk factors for requiring tracheostomy and the impact of tracheostomy on outcomes in patients after Stanford type A acute aortic dissection surgery (AADS) are limited. Methods A retrospective single-institutional study including consecutive patients who underwent AADS between January 2016 and December 2019 was conducted. Patients who died intraoperatively were excluded. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for postoperative tracheostomy (POT). A nomogram to predict the probability of POT was constructed based on independent predictors and their beta-coefficients. The area under the receiver operating characteristic curve (AUC) was performed to assess the discrimination of the model. Calibration plots and the Hosmer–Lemeshow test were used to evaluate calibration. Clinical usefulness of the nomogram was assessed by decision curve analysis. Propensity score matching analysis was used to analyze the correlation between requiring tracheostomy and clinical prognosis. Results There were 492 patients included in this study for analysis, including 55 patients (11.2%) requiring tracheostomy after AADS. Compared with patients without POT, patients with POT experienced longer ICU and hospital stay and higher mortality. Age, cerebrovascular disease history, preoperative white blood cell (WBC) count and renal insufficiency, intraoperative amount of red blood cell (RBC) transfusion and platelet transfusion were identified as independent risk factors for POT. Our constructed nomogram had good discrimination with an AUC = 0.793 (0.729–0.856). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. For better clinical application, we defined four intervals that stratified patients from very low to high risk for occurrence of POT. Conclusions Our study identified preoperative and intraoperative risk factors for POT and found that requiring tracheostomy was related to the poor outcomes in patients undergoing AADS. The established prediction model was validated with well predictive performance and clinical utility, and it may be useful for individual risk assessment and early clinical decision-making to reduce the incidence of tracheostomy.

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“…However, robust evidence of these benefits is scarce. The best timing and technique for tracheostomy after cardiac surgery are still debated as well [ 65 , 66 , 67 , 68 , 69 ].…”

Section: Prolonged Ventilation and Tracheostomymentioning

confidence: 99%

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

Nicolotti

Grossi

Nicolini

et al. 2023

JCM

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Respiratory weaning after cardiac surgery can be difficult or prolonged in up to 22.7% of patients. The inability to wean from a ventilator within the first 48 h after surgery is related to increased short- and long-term morbidity and mortality. Risk factors are mainly non-modifiable and include preoperative renal failure, New York Heart Association, and Canadian Cardiac Society classes as well as surgery and cardio-pulmonary bypass time. The positive effects of pressure ventilation on the cardiovascular system progressively fade during the progression of weaning, possibly leading to pulmonary oedema and failure of spontaneous breathing trials. To prevent this scenario, some parameters such as pulmonary artery occlusion pressure, echography-assessed diastolic function, brain-derived natriuretic peptide, and extravascular lung water can be monitored during weaning to early detect hemodynamic decompensation. Tracheostomy is considered for patients with difficult and prolonged weaning. In such cases, optimal patient selection, timing, and technique may be important to try to reduce morbidity and mortality in this high-risk population.

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Tracheostomy in Patients Requiring Prolonged Mechanical Ventilation After Cardiac Surgery

Cited by 4 publications

References 11 publications

A Predictive Scoring Model for Postoperative Tracheostomy in Patients Who Underwent Cardiac Surgery

A Predictive Scoring Model for Postoperative Tracheostomy in Patients Who Underwent Cardiac Surgery

Predictors and outcomes of postoperative tracheostomy in patients undergoing acute type A aortic dissection surgery

Difficult Respiratory Weaning after Cardiac Surgery: A Narrative Review

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