Risk factors for and economic implications of prolonged ventilation after cardiac surgery

Rajakaruna, Chanaka; Rogers, Chris; Angelini, Gianni; Ascione, Raimondo

doi:10.1016/j.jtcvs.2005.06.050

Cited by 90 publications

(72 citation statements)

References 19 publications

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“…9,10 This difference in long-term survival, although not significant, might have been because of the definition of PMV, the relatively short period after the surgery, in our study. Survivors of PMV following cardiac surgery can enjoy a good quality of life after discharge from the hospital, 9 but a complicated postoperative course can influence not only in-hospital mortality and morbidity but also long-term outcomes in patients with AAAD.…”

Section: Discussioncontrasting

confidence: 50%

“…8,13,17 Previously reported risk factors for PMV after cardiac surgery include advanced age, female sex, obesity, COPD, smoking, history of stroke, renal failure, preoperative shock, preoperative use of IABP, concomitant valve surgery, previous cardiac surgery, large positive fluid balance, prolonged CPB and cross-clamp time, emergency surgery, and unstable angina. [8][9][10]12,13,[15][16][17] We found, however, preoperative shock, preoperative limb ischemia, concomitant CABG, and postoperative renal failure to be the only risk factors for PMV after surgery for AAAD. In fact, preoperative shock is reported to increase mortality in patients with AAAD, 21 and an initial systolic BP of <100mmHg is reported in approximately 25% of patients with aortic dissection.…”

Section: Discussionmentioning

confidence: 63%

“…8 Undoubtedly, the definition of PMV influences the reported mortality and morbidity rates. 10 Among cardiac surgery patients such as those treated by CABG, those who require PMV tend to have more severe comorbidity such as poor left ventricular function, history of ischemic heart disease, COPD, and chronic hemodialysis. In our AAAD patients, however, most of these underlying diseases were not associated with PMV.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 A number of studies regarding PMV following cardiac surgery have examined its predictors or its influence on clinical outcomes and costs. [8][9][10][11][12][13][14][15][16][17] However, little is known about PMV following AAAD surgery. The aim of this retrospective study was to identify predictors of PMV following AAAD surgery and to assess the influence of PMV on the short and long-term postoperative courses.…”

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confidence: 99%

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Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Kimura

Tanaka

Kawahito

et al. 2008

Circ J

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ompared to the relatively favorable in-hospital outcomes of acute type B aortic dissection, 1,2 acute type A aortic dissection (AAAD) remains one of the most serious cardiovascular diseases associated with a high mortality. The latest report from the International Registry of Acute Aortic Dissection Investigators group indicated that in-hospital mortality remains high (163 of 682 patients (23.9%) with AAAD treated surgically between 1996 and 2003). 3 With such critical illness, some patients require prolonged mechanical ventilation (PMV) after surgery. Compared with patients who undergo other cardiac surgeries, patients with AAAD are more likely to suffer preoperative hemodynamic instability, organ malperfusion, and prolonged cardiopulmonary bypass (CPB) during surgery. In addition, re-exploration for bleeding and neurological deficits are common postoperative complications in these patients. 4 All these factors can contribute to PMV after AAAD surgery. 5 Another factor related to the PMV is systemic inflammatory response-related lung injury evoked by acute aortic dissection. 6,7 A number of studies regarding PMV following cardiac surgery have examined its predictors or its influence on clinical outcomes and costs. [8][9][10][11][12][13][14][15][16][17] However, little is known about PMV following AAAD surgery. The aim of this retrospective study was to identify predictors of PMV following AAAD surgery and to assess the influence of PMV on the short and long-term postoperative courses. MethodsFrom January 1997 through to December 2006, 243 consecutive patients with AAAD underwent emergency surgery at our hospital. Aortic dissection was diagnosed by means of enhanced computed tomography scan or echocardiography, and transesopageal echocardiography was used for confirmation when possible. In all patients, emergency surgery was performed within 14 days after the onset of symptoms; 90% of these surgeries were performed within 48 h. So that we could focus on PMV, 10 patients who died within 48 h after surgery were excluded from the study. Death within 48 h after surgery was due to profound cardiac failure (8 patients) or refractory bleeding (2 patients). The remaining 233 patients (120 men, 113 women, mean age: 63.4±11.2 years) were divided into 2 groups according to the duration of mechanical ventilation: those who were tracheally extubated within 48 h after admission to the intensive care unit (ICU) (group A, n=149) and those who required mechanical ventilation for more than 48 h (group B, n=84). Patients who were reintubated within 24 h after extubation were considered to have an interrupted period of ventilation. To identify the independent predictors for PMV, we compared 48 perioperative factors (25 preoperative factors and 23 intra or postoperative factors) between the 2 groups. Mortality and morbidity, length of the ICU and hospital stays, and long-term survival were compared

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Kimura

Tanaka

Kawahito

et al. 2008

Circ J

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“…Some authors in their studies refer alternatively to preoperative, intraoperative and immediately postoperative parameters, others showed that hemodynamic status on ICU admission and early postoperative events were more important than intraoperative variables, to predict ventilatory dependence, defined as MV greater than 72 hours after cardiac surgery (Cislaghi et al, 2009;Rajakaruna et al, 2005).…”

Section: Timing Of the Tracheotomymentioning

confidence: 99%

Endoscopic Percutaneous Tracheotomy in Prolonged Intubation of Mechanical Ventilated Patients Admitted in Cardio-Thoracic Intensive Care Unit

Mastropierro¹,

Bettinzoli²,

Manzato³

2012

Global Perspectives on Bronchoscopy

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Relationship Between Occurrence of Surgical Complications and Hospital Finances

Eappen¹,

Lane²,

Rosenberg³

et al. 2013

JAMA

184

132

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Risk factors for and economic implications of prolonged ventilation after cardiac surgery

Abstract: Prolonged ventilation is associated with high in-hospital mortality and costs, and poor 5-year survival. Identified predictors of prolonged ventilation might help to optimize the clinical management of these patients.

Cited by 90 publications

References 19 publications

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Risk Factors for Prolonged Mechanical Ventilation Following Surgery for Acute Type A Aortic Dissection

Endoscopic Percutaneous Tracheotomy in Prolonged Intubation of Mechanical Ventilated Patients Admitted in Cardio-Thoracic Intensive Care Unit

Relationship Between Occurrence of Surgical Complications and Hospital Finances

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