Prolonged ventilatory support after open-heart surgery

LoCicero, Joseph; McCann, Brian T.; Massad, Malek G.; Joob, Axel W.

doi:10.1097/00003246-199207000-00015

Cited by 46 publications

(22 citation statements)

References 9 publications

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“…This percentage is compatible with those of other reports in the literature 1,14,15 . The causes of failure to wean from mechanical ventilation in these patients related mainly to the presence of cardiac dysfunction and prolonged time of extracorporeal circulation.…”

Section: Discussionsupporting

confidence: 93%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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OBJECTIVE: To analyze parameters of respiratory system mechanics and oxygenation and cardiovascular alterations involved in weaning tracheostomized patients from long-term mechanical ventilation after cardiac surgery. METHODS: We studied 45 patients in their postoperative period of cardiac surgery, who required long-term mechanical ventilation for more than 10 days and had to undergo tracheostomy due to unsuccessful weaning from mechanical ventilation. The parameters of respiratory system mechanics, oxigenation and the following factors were analyzed: type of surgical procedure, presence of cardiac dysfunction, time of extracorporeal circulation, and presence of neurologic lesions. RESULTS: Of the 45 patients studied, successful weaning from mechanical ventilation was achieved in 22 patients, while the procedure was unsuccessful in 23 patients. No statistically significant difference was observed between the groups in regard to static pulmonary compliance (p=0.23), airway resistance (p=0.21), and the dead space/tidal volume ratio (p=0.54). No difference was also observed in regard to the variables PaO2/FiO2 ratio (p=0.86), rapid and superficial respiration index (p=0.48), and carbon dioxide arterial pressure (p=0.86). Cardiac dysfunction and time of extracorporeal circulation showed a significant difference. CONCLUSION: Data on respiratory system mechanics and oxygenation were not parameters for assessing the success or failure. Cardiac dysfunction and time of cardiopulmonary bypass, however, significantly interfered with the success in weaning patients from mechanical ventilation

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Section: Discussionsupporting

confidence: 93%

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Nozawa¹,

Kobayashi²,

Matsumoto³

et al. 2003

Arq. Bras. Cardiol.

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“…Similar results have been reported by Wahl, et al 15) However, our study did reveal a higher frequency of cardiac complications (low cardiac output, arrhythmias, cardiac arrest and bleeding) during the intraoperative period in the group that failed weaning. These results are consistent with the previous identification of intraoperative events such as myocardial failure 6) and surgical reexploration due to bleeding 2) as factors that lead to failure of weaning from mechanical ventilation after cardiac surgery. In our study, the type of surgical pro- cedure, the mean duration of the surgery, and the mean CPB time did not appear to affect the success or failure of weaning from long-term mechanical ventilation.…”

Section: Pre-and Intraoperative Clinical Factorssupporting

confidence: 92%

“…[3][4][5] However, approximately 3% to 6% of the patients admitted to the adult ICU require prolonged mechanical ventilation, and criteria and strategies for their successful weaning are less clear. 6) Parameters of respiratory mechanics and oxygenation are commonly used to wean patients with chronic obstructive pulmonary disease (COPD) and other pulmonary disorders from long-term mechanical ventilation. [7][8][9] Yet, as we have previously shown, 10) arterial blood gas analysis and the determination of vital capacity and minute volume often fail to predict extubation success in patients after cardiac surgery.…”

mentioning

confidence: 99%

“…Others have identified advanced age, female sex, (extended) time of extracorporeal circulation, cardiac dysfunction, and low cardiac output as factors associated with the failed weaning of cardiac patients from long-term ventilation 2,4,5) and postoperative cardiac dysfunction and neurological alterations, as factors contributing to their high mortality. 6) But few reports have described parameters of respiratory mechanics, oxygenation, and organ function associated with successful weaning in this population. Therefore, the primary objective of the present study was to analyze pre-, intra-and postoperative data from 52 patients who underwent tracheostomy and long-term mechanical ventilation after cardiac surgery to identify factors associated with successful or failed weaning.…”

mentioning

confidence: 99%

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Factors Associated With Failure of Weaning From Long-term Mechanical Ventilation After Cardiac Surgery

Nozawa

Azeka

Z³

et al. 2005

Int. Heart J.

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SUMMARYThe purpose of this prospective, quantitative, comparative study, conducted at the 55 bed cardiothoracic intensive care unit of the Heart Institute (InCor), University of Sao Paulo Medical School, was to identify factors involved in the weaning of patients who require long-term (> 10 days) mechanical ventilation after cardiac surgery.The subjects included all patients who underwent open-heart surgery with cardiopulmonary bypass during a 10 month period from April 2000 to January 2001 (n = 946). From this group, 52 (5.7%) patients who required a tracheotomy for the management of long-term mechanical ventilation after cardiac surgery with cardiopulmonary bypass were selected. Pre-, intra-and postoperative data from patients who were not successfully weaned after reintubation and who underwent an elective tracheotomy were compared.Parameters of respiratory mechanics such as respiratory complications, oxygenation, and cardiac, renal, and neurological function were evaluated. Weaning success was defined as the ability of a patient to tolerate 48 hours without pressure or flow support from a mechanical ventilator. A patient was considered to have failed weaning if they died or remained under ventilation for more than 8 weeks. Of the 52 patients studied, 25 were successfully weaned, 21 died, and 6 remained ventilated for more than 8 weeks. We found significant statistical differences (P <0.05) between the groups with respect to success or failure in LVEF (P = 0.0035), the need for vasoactive agents (P = 0.0018), and renal failure (P = 0.002). Parameters of respiratory mechanics and oxygenation (eg, static airway compliance, airway resistance) did not influence the success or failure of weaning. There was a significant difference in relation to the presence of pneumonia (P = 0.0086) between the two groups. Although neurological complications were more frequent in patients in the weaning success group, the failure group had lower GCS scores, which is indicative of worse prognoses.It is concluded that cardiac dysfunction, the need for dialysis, and pneumonia are determinants for weaning failure in patients undergoing long-term mechanical ventilation after cardiac surgery. (Int Heart J 2005; 46: 819-831)

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“…The operative field is viewed directly without requirement for video-assisted visualization or specialized instrumentation. [8] The incision may be easily and rapidly extended to a full sternotomy in case of technical problems or if exposure is not adequate, in contrast to paramedian, transverse sternal, or intercostal incisions, which are more difficult to extend. [9] Complete coronary revascularization to all branches of the coronary arteries including those on the posterior wall of the left ventricle in the circumflex distribution can be performed through a ministernotomy incision on CPB using traditional graft conduits, including the internal mammary artery, radial artery, and saphenous vein.…”

Section: Discussionmentioning

confidence: 99%

A comparison of lower ministernotomy (manubrium-sparing sternotomy) and standard median sternotomy in coronary artery bypass surgery

Kaya¹,

Çolak²,

Ceviz³

et al. 2017

Turk Gogus Kalp Dama

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A comparison of lower ministernotomy (manubrium-sparing sternotomy) and standard median sternotomy in coronary artery bypass surgery Bul gu lar: Gruplar arasında kros-klemp süresi, kardiyopulmoner baypas süresi ve toplam işlem süresi açısından istatistiksel olarak anlamlı bir fark yoktu. Göğüs tüpü drenaj miktarı, ministernotomi grubunda daha düşük olan ameliyat sonrası kan transfüzyonu ihtiyacı ve ministernotomi grubunda daha yüksek olan ameliyat sonrası hematokrit düzeyleri, ameliyat sonrası hemoglobin düzeyleri ve ameliyat sonrası SaO 2 düzeyleri arasında istatistiksel olarak anlamlı bir fark vardı. Ventilasyon süresi ve yoğun bakım ünitesinde ve hastanede kalma süresi ministernotomi grubunun lehine istatistiksel olarak anlamlı idi. Bu çalışmada mortalite oranları açısından iki grup arasında istatistiksel olarak anlamlı bir fark yoktu.So nuç: Çalışma sonuçlarımız manibrium koruyucu sternotominin özellikle obez, diyabetik ve solunum fonksiyonu kötü olan hastalarda, klasik medyan sternotomi cerrahisine iyi bir alternatif olabileceğini göstermektedir.Anah tarsöz cük ler: Koroner arter baypas greftleme; minimal invaziv cerrahi işlem; sternotomi. ABSTRACT Background:In this study, we aimed to compare early outcomes of lower ministernotomy (manubrium-sparing sternotomy) and standard median sternotomy in coronary artery bypass grafting surgery. Methods:Between January 2015 and December 2016, a total of 28 patients (15 males, 13 females; mean age 64.5±10.1 years; range 43 to 82 years) who underwent coronary artery bypass grafting surgery at the Department of Cardiovascular Disease were retrospectively analyzed. Of these patients, 14 patients were operated with lower ministernotomy (manubrium-sparing sternotomy; group 1) and 14 patients were operated using standard median sternotomy (group 2). Data including age, gender, body surface area, preoperative clinical findings, intraoperative variables, postoperative complications, the amount of transfusion products, hemoglobin and hematocrit values, drainage volumes, intubation duration, mortality, and length of intensive care unit and hospital stay of both groups were compared retrospectively.Results:There was no statistically significant difference in the crossclamp time, cardiopulmonary bypass time, and total procedure time between the groups. There was a statistically significant difference in the amount of chest tube drainage, the need for blood transfusion which was lower in the ministernotomy group, and postoperative hematocrit levels, postoperative hemoglobin levels and postoperative SaO 2 levels which were higher in the ministernotomy group. There was a statistically significant difference in the ventilation time and length of stay in the intensive care unit and hospital in favor of the ministernotomy group. The study showed no statistically significant difference in the mortality rate between the two groups. Conclusion:Our study results show that the manubrium-sparing sternotomy may be a feasible alternative to surgery through classical median sternotomy for, pa...

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Prolonged ventilatory support after open-heart surgery

Cited by 46 publications

References 9 publications

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Assessment of factors that influence weaning from long-term mechanical ventilation after cardiac surgery

Factors Associated With Failure of Weaning From Long-term Mechanical Ventilation After Cardiac Surgery

A comparison of lower ministernotomy (manubrium-sparing sternotomy) and standard median sternotomy in coronary artery bypass surgery

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