Influence of Remifentanil/Propofol Anesthesia on Ventilator-associated Pneumonia Occurence After Major Cardiac Surgery

Abstract

The study is designed to evaluate the influence of remifentanil/propofol anesthesia on ventilator-associated pneumonia (VAP) occurrence and respiratory support (RS) time after major cardiac surgery.Material and methods:In retrospective-prospective study we investigated the respiratory support time and VAP occurrence in group of 47 patients with remifentanil/propofol and 35 patients with fentanil/midazolam anesthesia after major cardiac surgery in period June 2009–December 2011. Groups are divided in subgroups depending of who underwent cardiac surgery with or without cardiopulmonary by pass (CPB).Results:The time of respiratory support (RS) was the shortest in remifentanil group without CPB (R/Off 63min ± 44.3 vs R/On 94min ± 49.2 p=0,22), but was longer in fentanil group (F/Off 142 min ± 102.2 vs F/On 212 min ± 102.2 p=0.0014). The duration of RS of ON pump remifentanil group was shorter than in ON pump fentanil group (R/On 94 min vs F/On 212 min p=0.0011). The time of RS of OFF pump remifentanil group was lower than in Off pump entangle group (R/Off 63min ± 44,3 vs F/Off 142min ± 102.2 p=0,021) with statistically significance. Ventilator–associated pneumonia was detected in 7 patients (8.5 %). Six patients (17.1%) were from entangle group and one patient (2.1%) from remifentanil group. The most common isolates were Pseudomonas aeruginosa in all patients and both Pseudomonas aeruginosa and Klebsiella pneumonia in one patient.Conclusion:The remifentanil anesthesia regimen in cardiac surgery decreases length of respiratory support duration and can prevent development of VAP. The role of remifentanil anesthesia in preventing VAP, as one of the most important risk factor of in-hospital mortality after cardiac surgery is still incompletely understood and should be investigated further.

Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: a retrospective, propensity score matched cohort study of a four-year single center experience

“…In our study the incidences of pneumonia was significantly lower in the LVAD ultra group versus the LVAD match group. These findings support those of Kurihara et al and Kradzalic et al [ 27 , 28 ], who demonstrated a lower incidence of ventilator-associated pneumonia after FTA. Despite that the incidence of sepsis did not differ significantly between the two matched groups, a tendency for lower incidence of sepsis in the LVAD ultra could be detected ( p = 0.055).…”

Obesity Increases Risk‐Adjusted Morbidity, Mortality, and Cost Following Cardiac Surgery

“…37,38 Use of anesthetic agents that are more rapidly eliminated may reduce length of respiratory support duration and can prevent development of ventilator-associated pneumonia in obese patients. 39 In this study, obesity was a protective factor for bleeding, as obese patients were less likely to receive blood products. Similar findings have been reported in prior studies.…”

“…Perioperative physiotherapy was found to decrease the prevalence of postoperative pneumonia in high‐risk patients and is strongly recommended by some studies . Use of anesthetic agents that are more rapidly eliminated may reduce length of respiratory support duration and can prevent development of ventilator‐associated pneumonia in obese patients …”

“…. Obese (BMI[30][31][32][33][34][35][36][37][38][39][40] and morbidly obese (BMI >40) patients composed 40.8% (n=5586) of the cohort. Obesity was associated with younger age and increased comorbidities of DM and hypertension compared to normal weight patients.…”

Interpretation for practice guidelines for prevention, diagnosis, and treatment of ventilator-associated pneumonia in burn patients by american burn association

“…Many studies have shown that a delay in the initiation of appropriate antibiotic therapy for patients with VAP has association with increased morbidity, cost of care, and mortality whether VAP is early or late in onset [ 30 , 31 ]. Therefore, once a patient is diagnosed with VAP, broad-spectrum antibiotic therapy should be adopted immediately targeting specific likely pathogens based on timing of VAP onset and modified by knowledge of local patterns of antibiotic resistance.…”