Chest
Volume 107, Issue 5, May 1995, Pages 1395-1401
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Clinical Investigations in Critical Care
Determinants of Mortality and Multiorgan Dysfunction in Cardiac Surgery Patients Requiring Prolonged Mechanical Ventilation

https://doi.org/10.1378/chest.107.5.1395Get rights and content

Objectives

To identify characteristics associated with mortality and the development of multiorgan dysfunction in patients who had undergone cardiac surgery and required prolonged mechanical ventilation, ie, >48 h.

Setting

Barnes Hospital, St. Louis, an academic tertiary care center.

Patients or other participants

A total of 107 consecutive patients undergoing cardiac surgery and requiring prolonged mechanical ventilation.

Interventions

Prospective patient surveillance and data collection.

Main outcome measures

ICU mortality and multiorgan dysfunction.

Results

Among 472 consecutive patients admitted to the cardiac surgery ICU following surgery, 107 (22.7%) required prolonged mechanical ventilation. Twenty-one of these patients (19.6%) died during their hospitalization. In a logistic-regression analysis, the development of an organ system failure index (OSFI) of 3 or greater was the only characteristic independently associated with ICU mortality (p<0.001). The occurrence of an antibiotic-resistant infection (adjusted odds ratio [AOR]=6.1, 95% confidence interval [CI]=2.5 to 14.6, p=0.006), an aortic cross-clamp time equal to or greater than 1.25 h (AOR=3.9, CI=2.3 to 6.8, p=0.016), the development of ventilator-associated pneumonia (AOR= 3.6, CI=2.4 to 5.3, p<0.001), and an APACHE III score equal to or greater than 30 (AOR=3.1, 0=1.8 to 5.3, p=0.036) were independently associated with the development of an OSFI of 3 or greater.

Conclusions

These data confirm that acquired multiorgan dysfunction is the best predictor of mortality in patients requiring prolonged mechanical ventilation following cardiac surgery. Additionally, they identify potential determinants of multiorgan dysfunction and suggest possible interventions for its reduction in this patient population.

Section snippets

Study Location and Population

The study was conducted at Barnes Hospital, St. Louis, an 1,100-bed private teaching hospital, between August 1993 and March 1994. All patients admitted to the cardiac surgery ICU (17 beds) who required mechanical ventilation for longer than 48 h were prospectively evaluated. Patients requiring mechanical ventilation for 48 h or less were prospectively excluded to select a population cohort with a significant rate of outcome events following cardiac surgery.12,15

Data Collection

The investigators made all

Demographics

A total of 472 consecutive postoperative patients requiring mechanical ventilation were admitted to the cardiac surgery ICU during the study period. Of these patients, 107 (22.7%) required mechanical ventilation for greater than 48 h. The surgical procedures performed on the patients requiring prolonged mechanical ventilation included 68 coronary artery bypass operations (63.6%), 12 valve operations (11.2%), 7 combined valve and coronary artery bypass procedures (6.5%), 11 surgeries involving

Discussion

This analysis confirms that the development of multiorgan dysfunction is the most important determinant of mortality for patients who had undergone cardiac surgery and required prolonged mechanical ventilation, ie, >48 h.12 Additionally, the occurrence of multiorgan dysfunction was independently associated with the emergence of antibiotic-resistant infection, an aortic cross-clamp time equal to or greater than 1.25 h, the development of VAP, and an APACHE III score equal to or greater than 30.

Acknowledgment

The authors thank Lisa Schomaker for her secretarial assistance and Daniel P. Schuster, MD, and Michael Province, PhD, for their review of the manuscript.

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