Respiratory Failure after Open Descending Aortic Aneurysm Repair: Risk Factors and Outcomes

Miyashita, Fumihiro; Kinoshita, Takeshi; Suzuki, Tomoaki; Asai, Tomohiro

doi:10.5761/atcs.oa.20-00020

Cited by 5 publications

(4 citation statements)

References 14 publications

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“…Extracorporeal membrane oxygenation (ECMO) in adults who have undergone these procedures has been shown to be associated with better outcomes than conventional treatment. [1][2][3][4][5][6] However, these patients are likely to receive prolonged mechanical ventilation. Prolonged ventilatory support can leave patients without the ability to protect their airway.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery

Xin

Wang

et al. 2022

Perfusion

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Background Current practices regarding percutaneous dilatational tracheostomy in adult patients treated with extracorporeal membrane oxygenation (ECMO) after cardiac surgery is not completely defined. This study aimed to evaluate the safety of the percutaneous dilatational tracheostomy in patients with ECMO after cardiac surgery. Methods Between July 2017 and May 2021, 371 ECMO procedures were performed in more than 35,000 adult patients who underwent cardiac surgery in our hospital. Sixty-two patients underwent percutaneous dilatational tracheostomy (PDT) during or after ECMO. A retrospective analysis was performed comparing the incidence of complications and clinical outcomes of the two groups. Results Of the 371 patients treated with ECMO after adult cardiac surgery during the enrollment period, 22 (7.1%) and 40 (12.8%) underwent PDT during or after ECMO, respectively. The platelet count (PLT) of the day was significantly lower in the PDT during ECMO group (54 (34, 68) vs. 108 (69, 162) (thousands), p < 0.001)). The prothrombin time (PT) and activated partial thromboplastin time (APTT) of the day were longer in the PDT during ECMO group (15.8 (14.6, 19.9) vs. 13.8 (13.2, 15.2) seconds, p = 0.001, 43.8 (38.0, 49.4) vs. 35.2 (28.2, 40.9) seconds, p < 0.001, respectively). There was no significant difference in tracheotomy-related complications between the two groups. Significantly decreased ventilator time was observed in the PDT during ECMO group. Conclusions Despite poor coagulation of the day, PDT during ECMO is safe and can appropriately reduce the duration of mechanical ventilation compared with PDT after ECMO weaning in adult patients who have undergone cardiac surgery.

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Section: Introductionmentioning

confidence: 99%

Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery

Xin

Wang

et al. 2022

Perfusion

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“…Acute respiratory failure is the major cause for ICU admission and death in patients with cancer ( 19 , 20 ). Several studies have indicated that the in-hospital mortality of patients receiving open repair of descending thoracic aortic aneurysm with respiratory failure was higher than patients without respiratory failure ( 21 ). Another study also demonstrated that respiratory failure increased the hospital morality of lung cancer patients in ICUs by 3.00 times, which was an independent risk factor for hospital morality of lung cancer patients in ICUs ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

A prediction model for in-hospital mortality in intensive care unit patients with metastatic cancer

Gao

2023

Front. Surg.

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AimTo identify predictors for in-hospital mortality in patients with metastatic cancer in intensive care units (ICUs) and established a prediction model for in-hospital mortality in those patients.MethodsIn this cohort study, the data of 2,462 patients with metastatic cancer in ICUs were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Least absolute shrinkage and selection operator (LASSO) regression analysis was applied to identify the predictors for in-hospital mortality in metastatic cancer patients. Participants were randomly divided into the training set (n = 1,723) and the testing set (n = 739). Patients with metastatic cancer in ICUs from MIMIC-IV were used as the validation set (n = 1,726). The prediction model was constructed in the training set. The area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were employed for measuring the predictive performance of the model. The predictive performance of the model was validated in the testing set and external validation was performed in the validation set.ResultsIn total, 656 (26.65%) metastatic cancer patients were dead in hospital. Age, respiratory failure, the sequential organ failure assessment (SOFA) score, the Simplified Acute Physiology Score II (SAPS II) score, glucose, red cell distribution width (RDW) and lactate were predictors for the in-hospital mortality in patients with metastatic cancer in ICUs. The equation of the prediction model was ln(P/(1 + P)) = −5.9830 + 0.0174 × age + 1.3686 × respiratory failure + 0.0537 × SAPS II + 0.0312 × SOFA + 0.1278 × lactate − 0.0026 × glucose + 0.0772 × RDW. The AUCs of the prediction model was 0.797 (95% CI,0.776–0.825) in the training set, 0.778 (95% CI, 0.740–0.817) in the testing set and 0.811 (95% CI, 0.789–0.833) in the validation set. The predictive values of the model in lymphoma, myeloma, brain/spinal cord, lung, liver, peritoneum/pleura, enteroncus and other cancer populations were also assessed.ConclusionThe prediction model for in-hospital mortality in ICU patients with metastatic cancer exhibited good predictive ability, which might help identify patients with high risk of in-hospital death and provide timely interventions to those patients.

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“…Although a hemorrhagic tendency is not necessarily observed, tooth extraction or trauma may trigger chronic DIC that makes hemorrhagic control difficult. [82][83][84] Thrombocytopenia in patients with DIC complicating aortic aneurysm is generally mild, and their prothrombin time and activated partial thromboplastin time are often in the normal range, while their fibrin degradation product (FDP) and D-dimer levels are elevated. Several patients with DIC with enhanced fibrinolysis have an elevated FDP/D-dimer ratio, 85, 86 which is useful for its differentiation (See PQ 2).…”

Section: ▋ 21 Aortic Aneurysmmentioning

confidence: 99%

JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection

Ogino,

Iida,

Akutsu

et al. 2023

Circ J

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▋ 1.3.2 Location of AneurysmsAneurysms are classified into thoracic, thoracoabdominal, and abdominal aneurysms, which are further classified as follows: Thoracic: It is further classified into ascending, arch, and descending aortic aneurysms. Thoracoabdominal: The Crawford classification based on the range of replacement in thoracoabdominal aneurysm surgery (Figure 5). Abdominal: Abdominal aortic aneurysms are classified using the renal artery as the reference into the supra-and infra-renal segments. ▋ 1.3.3 CauseBased on the cause of the aneurysm, aortic aneurysms are classified into atherosclerotic, traumatic, inflammatory, infected, congenital, etc. Most of them are atherosclerotic aortic aneurysms. Advance Publication13 JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection is indicated for saccular aneurysms regardless of the size of the thickening (See PQ 1). Inflammatory aortic aneurysm: Aneurysm caused by inflammation. Although, in general, "inflammation" is a concept that includes infection, however, inflammatory aortic aneurysm does not include the aortic aneurysm with infection. Inflammatory periaortitis: A case with inflammation around the aorta but with less aortic dilation that does not meet the criteria of aneurysm. Infected aortic aneurysm: Aneurysm caused by infection. Rupture: Extravascular blood leakage due to damage to the arterial wall. Impending rupture: The absence of damage to the arterial wall despite the presence of aneurysmal pain. ▋ 4.2 Aortic DissectionDissecting aneurysm: Aortic dissection with aneurysmal formation. A general term that was previously used for overall aortic dissection. However, because in many cases with aortic dissection in acute phase does not meet the criteria for an aneurysm, aortic dissection in acute phase is now called, "acute aortic dissection." True lumen: The original arterial cavity. False lumen: A new cavity formed in the arterial wall (the term "dissection cavity" is not appropriate). Dissection flap: The (intima-media) septal wall. It used to be called "intimal dissection." However, it actually consists of intima and a part of the media. Tear: Intimal and medial tears of aortic dissection which is the site of communication between the true lumen and the false lumen. "Intimal tear" is also regularly used as a synonym for "tear". Entry: A site where blood flow enters from the true lumen to the false lumen. Re-entry: A site where blood flow enters from the false lumen to the true lumen. ("communication window" that is also used as a term for both entry and re-entry) Aortic dissection with patent false lumen: It is a synonym for "communicating aortic dissection", a type of aortic dissection in Europe classification. It is also called "classic dissection" or "double barrel aorta." One of the three types of aortic dissection in Japanese Aortic dissection with thrombosed false lumen: It is a synonym for "noncommunicating aortic dissection", a type of aortic dissection in Europe classification. One of the three ty...

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Respiratory Failure after Open Descending Aortic Aneurysm Repair: Risk Factors and Outcomes

Cited by 5 publications

References 14 publications

Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery

Percutaneous dilatation tracheotomy in patients on extracorporeal membrane oxygenation after cardiac surgery

A prediction model for in-hospital mortality in intensive care unit patients with metastatic cancer

JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection

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