Abstract
BackgroundFluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3–4) and patients with normal renal function (reference group).MethodsThis is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery.ResultsPatients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation.ConclusionsFluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.
Highlights
Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery
The goal of the current study is to access the time on mechanical ventilation after Coronary artery bypass grafting (CABG), comparing patients with normal renal function, patients with CKD not on dialysis, and patients on regular maintenance hemodialysis
Patients requiring more than 48 h of ventilation had a lower estimated glomerular filtration rate (eGFR), were more likely to be on maintenance dialysis and had similar Sequential organ failure assessment (SOFA) at the intensive care unit (ICU) admission, not taking into account the renal component
Summary
Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3–4) and patients with normal renal function (reference group). Mechanical ventilation in the postoperative period is needed until normothermia and hemodynamic stability is achieved [4]. Prolonged mechanical ventilation (PMV) has been described in 2.9 to 22% of patients submitted to CABG [2, 6]. The first 24 h of mechanical ventilation are dependent on multiple factors, including a patient’s preoperative condition, the complexity of surgical procedure, as well as intra- and postoperative complications [5]
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