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Research ArticleOriginal Research

Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery

Maria Dolores Fernandez-Zamora, Antonio Gordillo-Brenes, Esther Banderas-Bravo, José Andrés Arboleda-Sánchez, Rafael Hinojosa-Pérez, Eduardo Aguilar-Alonso, Ángel Herruzo-Aviles, Emilio Curiel-Balsera, Ángel Sánchez-Rodríguez, Ricardo Rivera-Fernández and the ARIAM Andalucía Group
Respiratory Care May 2018, 63 (5) 550-557; DOI: https://doi.org/10.4187/respcare.04915
Maria Dolores Fernandez-Zamora
ICU at Hospital Regional Carlos Haya, Málaga, Spain.
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Antonio Gordillo-Brenes
ICU at Hospital Puerta del Mar, Cádiz, Spain.
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Esther Banderas-Bravo
ICU at Hospital Regional Carlos Haya, Málaga, Spain.
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José Andrés Arboleda-Sánchez
ICU at Hospital Regional Carlos Haya, Málaga, Spain.
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Rafael Hinojosa-Pérez
ICU at Hospital Virgen del Rocio, Sevilla, Spain.
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Eduardo Aguilar-Alonso
ICU at Hospital Infanta Margarita, Cabra, Córdoba, Spain.
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  • For correspondence: eaguia@yahoo.es
Ángel Herruzo-Aviles
ICU at Hospital Virgen del Rocio, Sevilla, Spain.
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Emilio Curiel-Balsera
ICU at Hospital Regional Carlos Haya, Málaga, Spain.
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Ángel Sánchez-Rodríguez
ICU at Hospital Puerta del Mar, Cádiz, Spain.
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Ricardo Rivera-Fernández
ICU at Complejo Hospitalario Jaén, Spain.
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Abstract

BACKGROUND: Mortality among the small percentage of cardiac surgery patients receiving prolonged mechanical ventilation is high, but this issue appears to be inadequately addressed in guidelines.

METHODS: This study is a retrospective analysis of prospective, multi-center, and observational study in Spain including all adults undergoing cardiac surgery in 3 Andalusian hospitals between June 2008 and December 2012.

RESULTS: The study included 3,588 adults with mean ± SD age of 63.5 ± 12.8 y and with median (interquartile range) EuroSCORE of 5 (3–7) points. Prolonged mechanical ventilation (> 24 h) was required by 415 subjects (11.6%), with ICU mortality of 44.3% (184 subjects), and was not required by 3,173 subjects (88.4%), with ICU mortality of 3.1% (99 subjects, P < .001). Prolonged mechanical ventilation was associated with more complications and was required by 4.5% of subjects with a EuroSCORE <5, 11.2% with a score of 5–7, 27.2% with a score of 8–10, and 32.2% with a score > 10. In the multivariable analysis, ICU mortality was associated with illness severity, duration of bypass surgery, surgery type, and prolonged mechanical ventilation (odds ratio 15.19, 95% CI 11.56–22.09). The main cause of death was multiple organ failure and sepsis in subjects who required prolonged mechanical ventilation (50.3%) and cardiogenic shock in those who did not (59.2%).

CONCLUSION: Prolonged postoperative mechanical ventilation was required by 10–20% of cardiac surgery subjects, who constitute a specific group that represents most of the postoperative mortality, which is associated with multiple organ failure and sepsis.

  • cardiac surgery
  • mechanical ventilation
  • mortality
  • severity

Footnotes

  • Correspondence: Eduardo Aguilar-Alonso MD, Hospital Infanta Margarita, Avenida Góngora s/n 14940 Cabra (Córdoba) Spain. E-mail: eaguia{at}yahoo.es.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2018 by Daedalus Enterprises
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Respiratory Care: 63 (5)
Respiratory Care
Vol. 63, Issue 5
1 May 2018
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Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery
Maria Dolores Fernandez-Zamora, Antonio Gordillo-Brenes, Esther Banderas-Bravo, José Andrés Arboleda-Sánchez, Rafael Hinojosa-Pérez, Eduardo Aguilar-Alonso, Ángel Herruzo-Aviles, Emilio Curiel-Balsera, Ángel Sánchez-Rodríguez, Ricardo Rivera-Fernández, the ARIAM Andalucía Group
Respiratory Care May 2018, 63 (5) 550-557; DOI: 10.4187/respcare.04915

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Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery
Maria Dolores Fernandez-Zamora, Antonio Gordillo-Brenes, Esther Banderas-Bravo, José Andrés Arboleda-Sánchez, Rafael Hinojosa-Pérez, Eduardo Aguilar-Alonso, Ángel Herruzo-Aviles, Emilio Curiel-Balsera, Ángel Sánchez-Rodríguez, Ricardo Rivera-Fernández, the ARIAM Andalucía Group
Respiratory Care May 2018, 63 (5) 550-557; DOI: 10.4187/respcare.04915
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