A prospective evaluation of hemodynamic indexes to predict weaning from mechanical ventilation in patients after cardiac surgery

Galas, F; Hajjar, L; Lara, Thiago Martins; Nozawa, Emı́lia; Feltrim, Maria Ignêz Z.; Sundin, M; Kalil, Renato A. K.; Otávio, José

doi:10.1186/cc8464

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…First, cardiac and pulmonary compensations that were probably beyond normal compensations (or suspicious compensations) were observed. Suspicious cardiac compensations were defined as new arrhythmias, urine output < 0.5 ml/kg/h, Blood pressure (BP) and HR changed > weaning management [12]. NT-proBNP might be helpful such of this condition.…”

Section: Early and Late-weaning Outcomesmentioning

confidence: 99%

N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes

Sindhvananda¹,

Chonlada²,

Nuthathai³

2019

Int J Anesthetic Anesthesiol

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Purpose: An increase of NT-proBNP has been proved to be a predictor for ventilator weaning failure in several medical conditions. However, relation between NT-proBNP and ventilator-weaning outcomes after cardiac surgery has not yet been elucidated. This study was to investigate relationship between blood NT-proBNP and ventilatorweaning outcomes.Methods: A prospective analytical study was at Cardiovascular-thoracic intensive care unit. Cardiac-surgery patients (age 18-80 Y, consented and without exclusion criteria) were included. Blood NT-proBNP was sampling at pre-operation time and at weaning. Early-weaning outcomes were categorized into simple, difficult, and prolong weaning. Late-weaning outcomes were reintubation and suspicious cardiopulmonary compensations. Blood NT-proBNPs were compared among/between early and late-weaning outcomes. Area under the curve and sensitivity/specificity at various cut-off values for poor weaning outcomes were analyzed.Results: A final of 134 patients were analyzed. The mean NT-proBNPs (pre-operation and weaning) were 1,417.8 and 4,532.5 pg/ml, respectively. wide variations of NT-proBNPs were observed. NT-proBNPs were not significantly related to difficult, prolong, and reintubation; but significantly related to suspicious cardiopulmonary compensations. AUC range were 0.43-0.65. Conclusions:NT-proBNP increased 4-5-fold after cardiac surgery. A significant increase was related to sympathetic activation, not weaning-induced LV load. Due to low sensitivity, NT-proBNPs were not good predictors for difficult or prolong weaning and reintubation in post cardiac surgery.

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Section: Early and Late-weaning Outcomesmentioning

confidence: 99%

N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes

Sindhvananda¹,

Chonlada²,

Nuthathai³

2019

Int J Anesthetic Anesthesiol

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“…The vasoactive-inotropic score (VIS) is calculated as a weighted sum of all administered inotropes and vasoconstrictors, reflecting pharmacological support of the cardiovascular system and it predicts mortality and morbidity after cardiac surgery. Even if there is no widely accepted definition of what is "difficult weaning from CPB," the dose of inotropes and vasopressors required during weaning is generally used for this purpose; high doses of vasoactive or inotropic agents (vasoactive-inotropic score > 10) are a mark of difficult CPB weaning and are associated with a high level of mortality during cardiac surgery [10]. Various drugs, such as catecholamines, phosphodiesterase-3 inhibitors, calcium sensitizers, and calcium salts are used to support hemodynamics during weaning from CPB.…”

Section: Introductionmentioning

confidence: 99%

Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study

Ștef,

Bodolea,

Bocșan

et al. 2024

JCM

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Background: There is emerging but conflicting evidence regarding the association between calcium biomarkers, more specifically ionized calcium and the prognosis of intensive care unit (ICU) postoperative cardiac patients. Methods: Our study investigated the relationship between ionized calcium, vitamin D, and periprocedural clinical events such as cardiac, neurologic and renal complications, major bleeding, vasoactive–inotropic score (VIS), and length of ICU and hospitalization. Results: Our study included 83 consecutive subjects undergoing elective major cardiac surgery requiring cardiopulmonary bypass. The mean age of the participants was 64.9 ± 8.5 years. The majority of procedures comprised isolated CABG (N = 26, 31.3%), aortic valve procedures (N = 26, 31.3%), and mitral valve procedures (N = 12, 14.5%). A difference in calcium levels across all time points (p < 0.001) was observed, with preoperative calcium being directly associated with intraoperative VIS (r = 0.26, p = 0.016). On day 1, calcium levels were inversely associated with the duration of mechanical ventilation (r = −0.30, p = 0.007) and the length of hospital stay (r = −0.22, p = 0.049). At discharge, calcium was inversely associated with length of hospital stay (r = −0.22, p = 0.044). All calcium levels tended to be lower in those who died during the 1-year follow-up (p = 0.054). Preoperative vitamin D levels were significantly higher in those who experienced AKI during hospitalization (median 17.5, IQR 14.5–17.7, versus median 15.3, IQR 15.6–20.5, p = 0.048) Conclusion: Fluctuations in calcium levels and vitamin D may be associated with the clinical course of patients undergoing cardiac surgery. In our study, hypocalcemic patients exhibited a greater severity of illness, as evidenced by elevated VIS scores, and experienced prolonged mechanical ventilation time and hospital stays. Additional larger-scale studies are required to gain a deeper understanding of their impact on cardiac performance and the process of weaning from cardiopulmonary bypass, as well as to distinguish between causal and associative relationships.

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A prospective evaluation of hemodynamic indexes to predict weaning from mechanical ventilation in patients after cardiac surgery

Cited by 2 publications

References 2 publications

N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes

N-Terminal Pro-Brain Natriuretic Peptide in Post Cardiac Surgery as a Predictor of Ventilator-Weaning Outcomes

Investigating Potential Correlations between Calcium Metabolism Biomarkers and Periprocedural Clinical Events in Major Cardiovascular Surgeries: An Exploratory Study

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