Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review

He, Siyi; Chen, Bocheng; Li, Wei; Yan, Junyan; Chen, Lin; Wang, Xuefeng; Ye, Xiao

doi:10.1016/j.jtcvs.2014.07.107

Cited by 113 publications

(92 citation statements)

References 33 publications

(44 reference statements)

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“…20 Furthermore, in cardiac surgery, the mortality associated with VAP has been reported to be around 40%. 24,25 In this study, the VAP incidence in a post-op cardiac surgery patient was 10% with a mortality of 4.7%. The latter although higher than when VAP did not occur, was still well below what was previously thought to be the mortality rate associated with VAP, considering that the current population (postop cardiac surgery patients) was different from the other reports (general ICU patients).…”

Section: Discussionmentioning

confidence: 57%

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Luckraz

Manga

Senanayake

et al. 2017

Journal of the Intensive Care Society

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Section: Discussionmentioning

confidence: 57%

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Luckraz

Manga

Senanayake

et al. 2017

Journal of the Intensive Care Society

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“…A 2014 meta-analysis showed that the prevalence of ventilator-associated pneumonia in all cardiac surgery patients was 6.37%, increasing to 35.2% in patients with greater than 48 hours of mechanical ventilation. 10 Delirium after cardiac surgery has an estimated incidence of 26% to 52% and has been associated with a longer period of mechanical ventilation in the elderly. 11,12 Using STS data, Crawford et al found that the outcomes of operative mortality, major morbidity, and prolonged hospital length of stay did not significantly increase until patients were intubated more than 12 hours after surgery.…”

Section: How Did This Number Come About?mentioning

confidence: 99%

Early Extubation After Cardiac Surgery: A Better Predictor of Outcome than Metric of Quality?

Goeddel¹,

Hollander

Evans

2018

Journal of Cardiothoracic and Vascular Anesthesia

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“…Healthcare-associated infections (HAIs) represent the leading cause of non-cardiac morbidity after cardiac surgery, 1 and pneumonia is particularly common and responsible for adverse patient outcomes. 2–4 Moreover, pneumonia is frequently cited as among the most costly and resource-intensive of all HAIs.…”

Section: Introductionmentioning

confidence: 99%

Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

Ailawadi

Chang

O’Gara

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

102

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Rationale Pneumonia remains the most common major infection after cardiac surgery despite numerous preventive measures. Objectives To prospectively examine the timing, pathogens, and risk factors, including modifiable management practices, for post-operative pneumonia and estimate its impact on clinical outcomes. Methods 5,158 adult cardiac surgery patients were prospectively enrolled in a cohort study across 10 centers. All infections were adjudicated by an independent committee. Competing risk models were used to assess the association of patient characteristics and management practices with pneumonia within 65 days of surgery. Mortality was assessed by Cox proportional hazards model, and length of stay using a multi-state model. Measurements and Main Results The cumulative incidence of p neumonia was 2.4% ,33% of which occurred after discharge. Older age, lower hemoglobin level, chronic obstructive pulmonary disease, steroid use, operative time and left ventricular assist device/heart transplant were risk factors. Ventilation time (24–48 vs ≤24 hours;HR,2·83; 95% CI,1·72–4·66; >48 hours HR,4·67; 95% CI,2·70–8·08), nasogastric tubes (HR,1·80; 95% CI,1·10–2·94), and each unit of blood cells transfused (HR,1·16; 95% CI,1·08–1·26) increased pneumonia risk. Prophylactic use of second-generation cephalosporins (HR,0·66; 95% CI, 0·45–0·97) and platelet transfusions (HR, 0·49, 95% CI, 0·30–0·79) were protective. Pneumonia was associated with a marked increase in mortality (HR,8·89; 95% CI,5·02–15·75), and longer LOS of 13·55 ± 1·95 days (bootstrap 95% CI,10·31–16·58). Conclusions Pneumonia continues to impose a major impact on the health of patients after cardiac surgery. Adjusting for baseline risk, several specific management practices were associated with pneumonia, which offer targets for quality improvement and further research.

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Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review

Abstract: VAP in patients after cardiac surgery is common and has a poor prognosis. It is mainly caused by gram-negative bacteria, and could be affected by a series of factors.

Cited by 113 publications

References 33 publications

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Cost of treating ventilator-associated pneumonia post cardiac surgery in the National Health Service: Results from a propensity-matched cohort study

Early Extubation After Cardiac Surgery: A Better Predictor of Outcome than Metric of Quality?

Pneumonia after cardiac surgery: Experience of the National Institutes of Health/Canadian Institutes of Health Research Cardiothoracic Surgical Trials Network

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