Ventilation mécanique prolongée après chirurgie cardiaque : étude auxiliaire de l’étude sur les besoins de transfusion en chirurgie cardiaque (TRICS III)

Abstract

Purpose Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications. Methods Four thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored. Results Prolonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications. Conclusion In this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors. Study registration www.ClinicalTrials.gov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-022-02319-9.

Risk factors and clinical prediction models for prolonged mechanical ventilation after heart valve surgery

“…Profound cardiac enlargement hampers proper lung expansion and compromises pulmonary function, contributing to extended postoperative ventilation in patients [ 29 , 30 ]. Concurrently, expanding the left atrial diameter also elevates the likelihood of atrial fibrillation and heart failure [ 31 , 32 ]. Previous research has established that impaired left ventricular function is linked to postoperative PMV, and atrial fibrillation also serves as a risk factor for PMV [ 24 , 27 ].…”

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

“…However, some patients may experience PI due to the disease itself, surgical procedures, and perioperative management. Due to variations in the definition of PI (ranging from 24 h to 14 days), previous studies have reported incidence rates of PI after CS ranging from 2.6% to 22.7% ( 3 ). This prolongs patient hospitalization and increases mortality rates while also delaying long-term functional recovery, thereby imposing a significant medical burden on patients.…”

“…The Society of Thoracic Surgeons (STS) defines prolonged intubation (PI) as requiring intubation for more than 24 h ( 2 ). PI can lead to extended ICU stays, an increased 30-day mortality rate for CS patients (14% vs. 1%, p < 0.05), and heightened rates of ineffective medical interventions ( 3 ). Consequently, the development of a reliable postoperative PI prediction model and the implementation of targeted early interventions for high-risk patients would be immensely advantageous.…”

Prediction of intraoperative red blood cell transfusion in valve replacement surgery: machine learning algorithm development based on non-anemic cohort

“…Thus, allogeneic transfusion is the standard treatment for perioperative anemia in patients undergoing cardiac surgery, and a wide variety of blood products have saved most patients’ lives. Historical cohort studies have consistently shown that allogeneic transfusion, particularly when administered intraoperatively, is related to increased postoperative complications, including infectious disease, renal failure, acute lung injury, and neurological adverse events ( 2 – 4 ). Our previous cohort study also revealed that intraoperative red blood cell (RBC) transfusion significantly increased the risk of postoperative hypoxemia in non-anemic adults undergoing isolated valve replacements ( 5 ).…”