Incidence and risk factors of Pulmonary Complications after Cardiopulmonary bypass.

Anjum Naveed,Hammad Azam,Mirza Ahmad Raza Baig,Rana Altaf Ahmad,Humayoun Ghulam Murtaza

doi:10.12669/pjms.334.12846

Abstract

Objective:To determine the frequency of post-operative pulmonary complications (PPCs) after cardio-pulmonary bypass and association of pre-operative and intraoperative risk factors with incidence of PPCs.Methods:This study was an observational analysis of five hundred and seventeen (517) patients who underwent cardiac surgery using cardiopulmonary bypass. Incidence of PPCs and risk factors of PPCs were noted. Logistic regression was applied to determine the association of pre-operative and intraoperative risk factors with incidence of PPCs.Results:Post-operative pulmonary complications occurred in 32 (6.2%) patients. Most common post-operative pulmonary complication was atelectasis that occurred in 20 (3.86%) patients, respiratory failure in 8 (1.54%) patients, pneumonia in 3 (0.58%) patients and acute respiratory distress syndrome in 1 (0.19%) patients. The main risk factor of PPCs were advance age ≥ 60 years [odds ratio 4.16 (1.99-8.67), p-value <0.001], prolonged CPB time > 120 minutes [odds ratio 3.62 (1.46-8.97) p-value 0.003], pre-op pulmonary hypertension [odds ratio 2.60 (1.18-5.73), p-value 0.016] and intraoperative phrenic nerve injury [odds ratio 7.06 (1.73-28.74), p-value 0.002]. Operative mortality was 9.4% in patients with PPCs and 1.0% in patients without PPCs (p-value 0.01).Conclusion:The incidence of post-operative pulmonary complications was 6.2% in this study. Advanced age (age ≥ 60 years), prolonged CPB time (CPB time > 120 minutes), pre-op pulmonary hypertension and intraoperative phrenic nerve injury are independent risk factors of PPCs after surgery.

Highlights

Despite many advances in perioperative care, post-operative pulmonary complications (PPCs) still remain the leading cause of morbidity and death after adult cardiac surgery.[1,2] PPCs are Correspondence: March 31, 2017 July 1, 2017 July 5, 2017 associated with increased length of hospital stay and these have a great influence on health care cost in cardiac surgery patients.[3]
Development of pulmonary complications after cardiopulmonary bypass is multi-factorial; alteration in the function of chest muscles and wall due to median sternotomy, systemic inflammatory response syndrome initiated by establishing cardiopulmonary bypass, phrenic nerve damage caused by administration of cold saline in the pericardial cavity during cardiac arrest and alveolar edema caused by left ventricular distension and elevated pressure in the pulmonary vasculature are considered the main contributing factors for this lethal complication.[4]
There was no significant difference in the incidence of pulmonary complications between the patients who underwent coronary artery bypass grafting (CABG) or valvular operations (Fig.1)

Summary

Introduction

Despite many advances in perioperative care, post-operative pulmonary complications (PPCs) still remain the leading cause of morbidity and death after adult cardiac surgery.[1,2] PPCs are Correspondence: March 31, 2017 July 1, 2017 July 5, 2017 associated with increased length of hospital stay and these have a great influence on health care cost in cardiac surgery patients.[3]. Very few studies have focused on the intraoperative and postoperative risk factors responsible for the development of pulmonary complications in patients undergoing cardiac surgery using cardiopulmonary bypass.[6,7] In present study we determined the frequency of post-operative pulmonary complications (PPCs) and inter-operative factors associated with PPCs in patients undergoing cardiac surgery using cardio-pulmonary bypass

Methods

Results

Conclusion