Predictive Factors of Prolonged Ventilation Following Cardiac Surgery with Cardiopulmonary Bypass

Abstract

Introduction In this trial, we initially aimed to investigate the major predictive factors for prolonged mechanical ventilation (PMV) following cardiac surgery with cardiopulmonary bypass (CPB) in our center and, secondarily, we tried to find out the effects of the independent factors on mortality. Methods Between July 2017 and August 2018, 207 patients who underwent cardiac surgery with CPB were retrospectively investigated. The patients were randomly divided into two subgroups according to the duration of ventilator dependence (group 1 <24 hours, n=164, 79%; group 2 >24 hours, n=43, 21%). Results 207 patients (mean age 59.47±10.56) who underwent cardiac surgery with CPB were enrolled in this study (n=145, 70% of male patients; n=62, 30% of female patients). Amid these patients, 43 (n=43, 20.77%) had prolonged intubation time. After multivariate logistic regression analysis among preoperative factors, female gender (OR=2.321, P =0.028), leukocytosis (OR=1.233, P =0.006), perioperative lactate level (OR=1.224, P =0.027), CPB time (OR=1.012, P =0.012) and postoperative revision for bleeding (OR=23.125, P =0.040) were significantly detected. The effect of predictive factors on mortality after cardiac surgery was determined and found that PMV did not affect hospital mortality (OR=1.979, P =0.420). Conclusion In our report, we revealed, differently from previous studies, that intraoperative lactate levels which manifest organ perfusion and oxygenation were included and were significantly different in the early extubation group compared to the PMV group. Female gender, preoperative leukocytosis, intraoperative CPB time, lactate levels and postoperative revision for bleeding were the independent predictive factors for PMV. Moreover, PMV did not affect the early-term mortality during hospital stay.

Blood Transfusion Predicts Prolonged Mechanical Ventilation in Acute Stanford Type A Aortic Dissection Undergoing Total Aortic Arch Replacement

“…Only two studies have confirmed that leukocytosis is a risk factor for PMV after cardiovascular surgery, one had PMV ≥24 h after cardiac surgery with CPB, and the other had PMV ≥72 h after acute DeBakey type I aortic dissection surgery (45,46). Similar results were obtained; preoperative leukocytosis was an independent risk factor for two endpoints of PMV ≥24 h and ≥72 h in ATAAD after TAR.…”

A study of mechanical ventilation in the ICU after cardiac surgery: a bibliometric analysis

“…Tian et al compared the effects of remifentanil and sufentanil/fentanyl on the postoperative mechanical ventilation time of cardiac surgery patients, and found that remifentanil significantly shortened the postoperative mechanical ventilation time and reduced myocardial injury (16). Some researchers have confirmed that the use of sedation, and sucralfate, and the appropriate use of antibiotics reduces the risk of respiratory and related pneumonia after patients are transferred to the ICU after surgery, thereby avoiding PMV (17). Other studies have found that the use of invasive and non-invasive sequential mechanical ventilation effectively reduces the time of mechanical ventilation and reduces the incidence of respiratory complications (18,19).…”

The early and long-term outcomes of coronary artery bypass grafting added to aortic valve replacement compared to isolated aortic valve replacement in elderly patients: a systematic review and meta-analysis

“…The meta-analysis shows that PMV was significantly associated with the SAVR + CABG surgical operation. Longer CPB time is reported to be an independent predictor of postoperative respiratory failure [ 74 ] and PMV (> 24 h) [ 75 ]. Since SAVR + CABG operation has a CPB time longer than i-SAVR, we can argue that this factor might be determinant in increasing the incidence of postoperative PMV in patients who received CABG added to SAVR.…”