RT Journal Article
SR Electronic
T1 Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.04915
DO 10.4187/respcare.04915
A1 Maria Dolores Fernandez-Zamora
A1 Antonio Gordillo-Brenes
A1 Esther Banderas-Bravo
A1 José Andrés Arboleda-Sánchez
A1 Rafael Hinojosa-Pérez
A1 Eduardo Aguilar-Alonso
A1 Ángel Herruzo-Aviles
A1 Emilio Curiel-Balsera
A1 Ángel Sánchez-Rodríguez
A1 Ricardo Rivera-Fernández
A1 ,
YR 2018
UL http://rc.rcjournal.com/content/early/2018/01/30/respcare.04915.abstract
AB 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.