Long-Term Mortality After Pneumonia in Cardiac Surgery Patients

Ibáñez, J.; Riera, María; Amézaga, Rocío; Herrero, Jaime; Colomar, A.; Campillo-Artero, Carlos; Ibarra, J.I. Sáez de; Bonnín, Oriol

doi:10.1177/0885066614523918

Cited by 48 publications

(40 citation statements)

References 32 publications

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“…Comparable with our results, Angus et al [20] reported a 30-day mortality of severe CAP patients of 15%, and a recent multicenter European study analyzing 1106 ICU patients with CAP demonstrated a 28-day mortality of 17% [21]. To our knowledge, data on 1-year mortality of ICU patients with pneumonia are rare [22][23][24]. None of these studies was conducted in an all-medical ICU where pneumonia was the primary reason of stay.…”

Section: Discussionsupporting

confidence: 87%

Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis

Honselmann

Buthut

Heuwer

et al. 2015

Journal of Critical Care

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Section: Discussionsupporting

confidence: 87%

Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis

Honselmann

Buthut

Heuwer

et al. 2015

Journal of Critical Care

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“…Although a significant amount of research has focused on prevention 5‐8 and the cost of treating 9 ventilator‐associated pneumonia following cardiac surgery, the recent analysis of over 5000 prospectively enrolled cardiac surgery patients by Ailawadi et al 1 highlights the important point that nearly one‐third of postoperative pneumonias may be diagnosed after discharge from the index admission. While the development of postoperative pneumonia has been associated with significant in‐hospital mortality ranging from 23.7% 10 to 28%, 11 Ibanez et al 11 also demonstrated a significant association with reduced five‐year survival. Overall, Ailawadi et al 1 estimated that the development of postoperative pneumonia after cardiac surgery is associated with a nearly ninefold increased risk of mortality at postoperative day 65 and a nearly 2‐week increase in index length of stay 1 …”

Section: Introductionmentioning

confidence: 99%

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

et al. 2020

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Background The development of postoperative pneumonia following cardiac surgery is associated with significant morbidity and mortality. However, seasonal variation as a risk factor for the development of postoperative pneumonia remains to be investigated. We sought to investigate whether patients undergoing coronary artery bypass grafting (CABG) during “flu season” (Fall and Winter months) at increased risk of postoperative pneumonia. Materials and Methods A retrospective cohort study of patients undergoing CABG in the National Inpatient Sample between 2005 and 2015 was completed. Concomitant diagnosis of pneumonia was defined as the primary outcome. Secondary outcomes were defined to include pneumonia secondary to several known pathogens. Outcomes with significant differences between Fall/Winter and Spring/Summer groups were further analyzed with additive time series decomposition. Odds ratios were generated and adjusted for age, sex, elective status, and 29 other Agency for Healthcare Research and Quality comorbidity measures. Results A total of 238 757 and 277 941 patients undergoing CABG during Fall/Winter and Spring/Summer, respectively, were identified. A significantly increased risk of postoperative pneumonia (adjusted odds ratio [aOR] = 1.15) and infection with influenza (aOR = 4.08), Haemophilus influenzae (aOR = 1.40), and Streptococcus pneumoniae (aOR = 1.47) was observed among patients receiving CABG in Q1 (January‐March) compared to Q3 (July‐September). Conclusions There is a strong seasonality in the incidence of postoperative pneumonia after CABG which may persist across other cardiothoracic surgeries. In addition to optimizing infection control and perioperative care, cardiac surgeons should consider preoperative vaccination against seasonal influenza, H. influenzae, and S. pneumoniae to improve outcomes among high‐risk patients.

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“…Ventilator-acquired pneumonia (VAP) is a common postoperative complication and accounts for a large part of post-cardiac surgery morbidity and mortality. Incidence of VAP depends on numerous factors, including pulmonary collapse and atelectasis during cardiopulmonary bypass (CPB), lowering of bronchial arterial blood flow and systemic inflammation response syndrome during and after CPB [ 1 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

Low tidal volume mechanical ventilation against no ventilation during cardiopulmonary bypass heart surgery (MECANO): study protocol for a randomized controlled trial

Nguyen

Merzoug

Estagnasié

et al. 2017

Trials

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BackgroundPostoperative pulmonary complications are a leading cause of morbidity and mortality after cardiac surgery. There are no recommendations on mechanical ventilation associated with cardiopulmonary bypass (CPB) during surgery and anesthesiologists perform either no ventilation (noV) at all during CPB or maintain low tidal volume (LTV) ventilation. Indirect evidence points towards better pulmonary outcomes when LTV is performed but no large-scale prospective trial has yet been published in cardiac surgery.DesignThe MECANO trial is a single-center, double-blind, randomized, controlled trial comparing two mechanical ventilation strategies, noV and LTV, during cardiac surgery with CPB. In total, 1500 patients are expected to be included, without any restrictions. They will be randomized between noV and LTV on a 1:1 ratio. The noV group will receive no ventilation during CPB. The LTV group will receive 5 breaths/minute with a tidal volume of 3 mL/kg and positive end-expiratory pressure of 5 cmH2O. The primary endpoint will be a composite of all-cause mortality, early respiratory failure defined as a ratio of partial pressure of oxygen/fraction of inspired oxygen <200 mmHg at 1 hour after arrival in the ICU, heavy oxygenation support (defined as a patient requiring either non-invasive ventilation, mechanical ventilation or high-flow oxygen) at 2 days after arrival in the ICU or ventilator-acquired pneumonia defined by the Center of Disease Control. Lung recruitment maneuvers will be performed in the noV and LTV groups at the end of surgery and at arrival in ICU with an insufflation at +30 cmH20 for 5 seconds. Secondary endpoints are those composing the primary endpoint with the addition of pneumothorax, CPB duration, quantity of postoperative bleeding, red blood cell transfusions, revision surgery requirements, length of stay in the ICU and in the hospital and total hospitalization costs. Patients will be followed until hospital discharge.DiscussionThe MECANO trial is the first of its kind to compare in a double-blind design, a no-ventilation to a low-tidal volume strategy for mechanical ventilation during cardiac surgery with CPB, with a primary composite outcome including death, respiratory failure and postoperative pneumonia.Trial registrationClinicalTrials.gov, NCT03098524. Registered on 27 February 2017.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2321-9) contains supplementary material, which is available to authorized users.

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Long-Term Mortality After Pneumonia in Cardiac Surgery Patients

Abstract: Pneumonia remains a serious complication in patients operated for cardiac surgery and is associated with increased hospital mortality and reduced long-term survival.

Cited by 48 publications

References 32 publications

Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis

Long-term mortality and quality of life in intensive care patients treated for pneumonia and/or sepsis

Seasonality of postoperative pneumonia after coronary artery bypass grafting: A national inpatient sample study

Low tidal volume mechanical ventilation against no ventilation during cardiopulmonary bypass heart surgery (MECANO): study protocol for a randomized controlled trial

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