Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

He, Siyi; Wu, Fan; Wu, Xiaochen; Xin, Mei; Ding, Shilei; Wang, Jian; Ouyang, Hui; Zhang, Jinbao

doi:10.21037/jtd.2018.01.49

Cited by 27 publications

(33 citation statements)

References 25 publications

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“…Gram-positive organisms such as S. aureus and fungi such as C. albicans also played important roles, similar to previous findings (10). The overall mortality rate was similar to those reported in other studies (18,19). However, mortality among patients with pneumonia was much higher than that among patients without pneumonia, which is consistent with published papers (2), emphasizing the need to identify risk factors and high-risk patients.…”

Section: Discussionsupporting

confidence: 90%

Risk factors for postoperative pneumonia after cardiac surgery: a prediction model

Wang¹,

Huang²,

Wang³

et al. 2021

J Thorac Dis

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Background: Postoperative pneumonia is the main infectious complication following cardiac surgery and is associated with significant increases in morbidity, mortality and health care costs. The aim of this study was to identify potential risk factors related to the occurrence of postoperative pneumonia in adult patients undergoing cardiac surgery and to develop a predictive system. Methods: Adult patients who underwent open heart surgery in our institution between 2016 and 2019 were enrolled in this study. Preoperative and intraoperative variables were collected and analyzed. A multivariate prediction model for evaluating the risk of postoperative pneumonia was established using logistic regression analysis via forward stepwise selection, and points were assigned to significant risk factors based on their regression coefficient values.Results: Postoperative pneumonia occurred in 530 of the 5,323 patients (9.96%). Prolonged stays in the postoperative intensive care unit (ICU) and hospital, as well as higher mortality (25.66% versus 0.65%), were observed in patients with postoperative pneumonia. Multivariate analysis identified 13 independent risk factors including patient demographics, comorbidities, cardiac function, cardiopulmonary bypass (CPB) duration, and blood transfusion. The prediction model showed good discrimination (C-statistic: 0.80) and was well calibrated (Hosmer-Lemeshow χ 2 =7.907, P value =0.443). A 32-point risk score was generated, and then three risk intervals were defined. Conclusions:We derived and validated a prediction model for postoperative pneumonia after cardiac surgery incorporating 13 easily discernible risk factors. The scoring system may be helpful for individualized risk estimations and clinical decision-making.

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Section: Discussionsupporting

confidence: 90%

Risk factors for postoperative pneumonia after cardiac surgery: a prediction model

Wang¹,

Huang²,

Wang³

et al. 2021

J Thorac Dis

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“…Sepsis is also among the risk factors for the abovementioned syndromes. Therefore, the rate of VAE (118/453 [26.0%]) in our series was higher than those reported in other studies 32 . Our VAE cases include 23 (19.4%) VACs, 47 (39.8%) IVACs, and 48 (40.6%) possible VAPs.…”

Section: Discussioncontrasting

confidence: 76%

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

Fang

Huang

et al. 2020

Sci Rep

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We hypothesized that Ventilator-Associated Event (VAE) within 28 days upon admission to medical intensive care units (ICUs) can be a predictor for poor outcomes in sepsis patients. We aimed to determine the risk factors and associated outcomes of VAE. A total of 453 consecutive mechanically ventilated (MV) sepsis patients were enrolled. Of them, 136 patients had immune profile study. Early VAE (< 7-day MV, n = 33) was associated with a higher mortality (90 days: 81.8% vs. 23.0% [non-VAE], P < 0.01), while late VAE (developed between 7 and 28 days, n = 85) was associated with longer MV day (43.8 days vs. 23.3 days [non-VAE], P < 0.05). The 90-day Kaplan-Meier survival curves showed three lines that separate the groups (non-VAE, early VAE, and late VAE). Cox regression models with time-varying coefficient covariates (adjusted for the number of days from intubation to VAE development) confirmed that VAE which occurred within 28 days upon admission to the medical ICUs can be associated with higher 90-day mortality. The risk factors for VAE development include impaired immune response (lower human leukocyte antigen D-related expression, higher interleukin-10 expression) and sepsis progression with elevated SOFA score (especially in coagulation sub-score). Ventilator-associated event (VAE) 1,2 was proposed to overcome the limitations of only focusing on ventilatorassociated pneumonia (VAP) 3 surveillance in mechanically ventilated (MV) patients in the context of surveying quality improvement. The limitations of previous VAP surveillance, which is proven to be neither sensitive nor specific 4 , hindered its application in quality improvement programs 5. Although VAE surveillance was a promising early warning tool for VAP prevention 6 , VAP prevention bundle compliance was not associated with a reduced risk of VAE 7. VAEs are defined as respiratory deterioration after a period of improved or stable gas exchange. The definition of VAE shifted the focus of surveillance from pneumonia to all conditions caused by mechanical ventilation including infectious or noninfectious conditions. The purpose was to expand the scope of surveillance to include multiple serious complications in ventilated patients, not just pneumonia, as well as to make surveillance more objective, efficient, and suitable for electronic implementation. Sepsis patients developed life-threatening organ dysfunctions (e.g., acute respiratory failure) caused by dysregulated host immune response to infection 8-10. An increase in sequential organ failure assessment (SOFA) score (including respiratory and other five sub-scores) has prognostic accuracy for in-hospital mortality in sepsis patients in the intensive care units (ICUs) 11. Since mechanical ventilator support and aggressive fluid resuscitation

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“…In awake mechanically ventilated patients, instead of sedation, foot reflexology may help reduce ventilation time and its associated complications, such as pneumonia, length of hospital stay, or delirium [9,10,12,31]. Similar to our study, Ebadi et Further, the researchers did not provide a clear definition of weaning time.…”

Section: Discussionmentioning

confidence: 44%

“…Both agitation and medications that are used for its treatment, such as opioids and benzodiazepines, can delay weaning from mechanical ventilation [8], and increase the risk of postoperative complications, mortality, the length of hospitalization, and health care costs [9,10]. Ventilator-associated pneumonia is one of the most common nosocomial infections in the ICUs, affecting 10-30% of mechanically ventilated patients [11], and it is known that prolonged intubation can increase the risk of this infection in CABG patients [12]. An intubation time longer than 12 hours has also been linked to increased risk of delirium and hemofiltration post cardiac surgery.…”

Section: Introductionmentioning

confidence: 99%

The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial

Allahbakhhsian

Gholizadeh

Allahbakhshian

et al. 2020

Complementary Therapies in Clinical Practice

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Background and purpose: This study examined the effects of foot reflexology on agitation and extubation time of male patients following coronary artery bypass graft surgery. Materials and methods:In this randomized three-arm controlled clinical trial, participants (n=120) were randomly assigned to the intervention, placebo, or control groups. The intervention group received foot reflexology massage for 15 minutes. Agitation was assessed using the Richmond Agitation-Sedation Scale before the intervention (Time 1) and immediately (Time 2) and 10 minutes after the intervention (Time 3). Extubation time was measured as the time from gaining full consciousness to endotracheal extubation.Results: Agitation reduced in all groups from Time 1 to Time 3 (p˂0.05); however, the intervention group showed a significantly higher reduction at Time 2 (p<0.001) and Time 3 (p<0.001). Also, extubation time was significantly shorter in the intervention group (p<0.01). Conclusion:Foot reflexology may be introduced as a nursing intervention to facilitate the weaning process in the cardiac ICUs.

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Ventilator-associated events after cardiac surgery: evidence from 1,709 patients

Cited by 27 publications

References 25 publications

Risk factors for postoperative pneumonia after cardiac surgery: a prediction model

Risk factors for postoperative pneumonia after cardiac surgery: a prediction model

Risk factors and associated outcomes of ventilator-associated events developed in 28 days among sepsis patients admitted to intensive care unit

The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial

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