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The Journal of Cardiovascular Surgery 2002 October;43(5):633-41

language: English

Optimization of mechanical ventilation support following cardiac surgery

Simeone F., Biagioli B., Scolletta S., Marullo A. C. M., Marchet- ti L., Caciorgna M., Giomarelli P.

Institute of Thoracic and Cardiovascular Surgery University of Siena, Siena, Italy


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Background. Mechanical ventilation (MV) is essen­tial in ­the man­age­ment of ­patients ­that under­went car­diac sur­gery ­and car­di­o­pul­mo­nary ­bypass. It has ­been dem­on­strat­ed ­that MV depen­dence is direct­ly relat­ed to mor­bid­ity inci­dence ­and ­ICU ­length of ­stay, ­with a ­strong ­impact on eco­nom­ic ­cost. Therefore iden­tifi­ca­tion of meas­ures ­that ­can ­reduce MV inter­val, ­may ­reduce ­the inci­dence of res­pir­a­to­ry com­pli­ca­tions ­and ­length of hos­pi­tal­iza­tion. The ­aim of ­this ­study ­was to iden­ti­fy wean­ing index­es ­and ­adopt a wean­ing algo­rithm in ­order to opti­mize ven­til­a­to­ry sup­port ­after car­diac sur­gery.
Methods. Forty-­nine ­patients ­with ­low ­and medi­um Higgins ­risk ­score, ­who under­went, ­between Februa-ry ­and November 1999, elec­tive sur­gery at ­our Institution, ­were ­enrolled in ­this ­study. All ­patients ­were ran­dom­ized ­into ­2 ­groups: Group I (wean­ing ­group - 24 ­patients), extu­bat­ed ­with ­the ­aid of a wean­ing pro­to­col, ­and Group II (con­trol ­group - 25 ­patients), extu­bat­ed ­with con­ser­va­tive wean­ing, depen­dent on ­the ­physician’s sub­jec­tive clin­i­cal judg­ment. All ­patients ­were suc­cess­ful­ly ­weaned ­from mechan­i­cal sup­port.
Results. Intubation ­time ­was sig­nif­i­cant­ly low­er in ­Group I ­than ­Group II ­and “Fast Track Recovery” ­group (p=0.05). ­ICU ­length of ­stay ­was ­also sig­nif­i­cant­ly low­er in ­Group I (p=0.03). Analysis of wean­ing index­es ­did not ­show ­cut-­off ­points pre­dic­tive of suc­cess­ful wean­ing, ­except ­for PaO2/FiO2 ­ratio, ­which ­was high­er in ­Group I (p=0.02).
Conclusions. These ­results con­firm ­that ­the ­use of a wean­ing algo­rithm ­enables ­the MV inter­val ­and hos­pi­tal ­length of ­stay to be shor­tened, sug­gest­ing ­that it ­should be ­used in ­the man­age­ment fol­low­ing car­diac sur­gery.

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