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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Optimization of mechanical ventilation support following cardiac surgery

Simeone F., Biagioli B., Scolletta S., Marullo A. C. M., Marchetti 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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