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Cislaghi F. 1, Condemi A. M. 1, Corona A. 2
1 Department of Cardiac Anaesthesia, Luigi Sacco Hospital, Milan, Italy,
2 Centre for Intensive Care Medicine and Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
Background. Prolonged mechanical ventilation after heart surgery is associated with increased patient morbidity and mortality (4.9% vs 22-38%). A prospective observational cohort study was carried out to assess the predictors of prolonged mechanical ventilation and its impact on hospital survival in a cardiac surgical patient cohort admitted to our 8 bed postoperative ICU from January 1997 through June 2004.
Methods. All of the patient perioperative and ICU variables were input into an electronic database. Patients were divided into: 1) an Early Extubation group, undergoing a successful extubation within 12 h and 2) a Delayed Extubation group, needing mechanical ventilation longer than 12 h.
Results. A total of 3,269 patients undergoing a coronary artery bypass graft operation were admitted. A multivariate Logistic Regression model allowed us to identify: 1) redo surgery (OR = 3.090, 95% CI = 1.655-5.780); 2) cardiopulmonary bypass time longer than 91’ (OR = 1.390, 95% CI = 1.013-1.908); 3) intraoperative transfusions of more than 4 units of red blood cells (OR = 3.144, 95% CI = 2.331-4.255) or fresh frozen plasma (OR = 2.976, 95% CI = 1.984-4.830); and 4) left ventricular ejection fraction ≤ 30% (OR = 2.444, 95% CI 1.291-3.205) as independent predictors of prolonged mechanical ventilation. The Early Extubation group showed a significantly higher cumulative survival 180 days after the ICU admission (Log-Rank = 16.617, p=0.000).
Conclusion. This audit allowed us to assess a predictive model identifying a priori coronary artery bypass graft patients that are more likely to undergo prolonged mechanical ventilation.