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Clinical Investigations in Critical CareDeterminants of Mortality and Multiorgan Dysfunction in Cardiac Surgery Patients Requiring Prolonged Mechanical Ventilation
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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