Prolonged mechanical ventilation after CABG: Risk factor analysis
Journal of Cardiothoracic and Vascular Anesthesia, cilt.29, sa.1, ss.52-58, 2015 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 29 Sayı: 1
- Basım Tarihi: 2015
- Doi Numarası: 10.1053/j.jvca.2014.09.002
- Dergi Adı: Journal of Cardiothoracic and Vascular Anesthesia
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.52-58
- Anahtar Kelimeler: delayed extubation, CABG, risk factors, coronary artery surgery, postoperative ventilation
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective Prolonged ventilation (PV) after coronary artery bypass graft (CABG) surgery is a common postoperative complication. Preoperative and operative parameters were evaluated in order to identify the patients at risk for prolonged ventilation postoperatively in coronary artery bypass graft (CABG) patients. Design Retrospective. Setting Research and training hospital, single institution. Participants The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients. Interventions The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis. Measurements and Main Results Forty-six patients (5.6%) required PV postoperatively. Hospital mortality was significantly higher in this group (45.7% v 4.0%; p = 0.0001). Univariate analysis showed that these patients were older (65.6±9.3 v 60.4±9.9; p = 0.001), had higher incidences of cerebrovascular disease (21.7% v 10.5%; p = 0.032), advanced ASA (58.7% v 41.8%; p = 0.026) and NYHA classes (32.6% v 12.2%; p = 0.001), and chronic renal dysfunction (20.0% v 4.0%; p = 0.0001). Concomitant procedures were more commonly performed in these patients (30.4% v 7.8%; p = 0.0001), and total durations of perfusion were longer (147.2±69.1 v 95.7±33.9 minutes; p = 0.0001). In regression analysis, advanced NYHA class (odds ratio = 8.2; 95% CI = 1.5-43.5; p = 0.015), chronic renal dysfunction (odds ratio = 7.7; 95% CI = 1.3-47.6; p = 0.027), and longer perfusion durations (p = 0.012) were found to be independently associated with delayed weaning from the ventilator. Every 1-minute increase over 82.5 minutes of cardiopulmonary bypass increased risk of delayed extubation by 3.5% (95% CI = 0.8%-6.4%). Conclusions Postoperative prolonged ventilation is associated with advanced NYHA class, chronic renal dysfunction and longer perfusion times in CABG patients.