Abstract
IntroductionIn this trial, we initially aimed to investigate the major predictive factors for prolonged mechanical ventilation (PMV) following cardiac surgery with cardiopulmonary bypass (CPB) in our center and, secondarily, we tried to find out the effects of the independent factors on mortality.MethodsBetween July 2017 and August 2018, 207 patients who underwent cardiac surgery with CPB were retrospectively investigated. The patients were randomly divided into two subgroups according to the duration of ventilator dependence (group 1 <24 hours, n=164, 79%; group 2 >24 hours, n=43, 21%).Results207 patients (mean age 59.47±10.56) who underwent cardiac surgery with CPB were enrolled in this study (n=145, 70% of male patients; n=62, 30% of female patients). Amid these patients, 43 (n=43, 20.77%) had prolonged intubation time. After multivariate logistic regression analysis among preoperative factors, female gender (OR=2.321, P=0.028), leukocytosis (OR=1.233, P=0.006), perioperative lactate level (OR=1.224, P=0.027), CPB time (OR=1.012, P=0.012) and postoperative revision for bleeding (OR=23.125, P=0.040) were significantly detected. The effect of predictive factors on mortality after cardiac surgery was determined and found that PMV did not affect hospital mortality (OR=1.979, P=0.420).ConclusionIn our report, we revealed, differently from previous studies, that intraoperative lactate levels which manifest organ perfusion and oxygenation were included and were significantly different in the early extubation group compared to the PMV group. Female gender, preoperative leukocytosis, intraoperative CPB time, lactate levels and postoperative revision for bleeding were the independent predictive factors for PMV. Moreover, PMV did not affect the early-term mortality during hospital stay.
Highlights
In this trial, we initially aimed to investigate the major predictive factors for prolonged mechanical ventilation (PMV) following cardiac surgery with cardiopulmonary bypass (CPB) in our center and, secondarily, we tried to find out the effects of the independent factors on mortality
Postoperative acute renal failure (ARF), lung infection, surgical infection, acute renal failure, revision for bleeding, revision of the surgical area, blood culture positivity, postoperative creatinine, troponin, C-reactive protein (CRP), ejection fraction (EF), leukocytosis and blood transfusion units, length of intensive care unit (ICU) stay and total hospitalization time were implicated in this study
We found that female gender, preoperative level of leukocytosis, intraoperative lactate levels, CPB time and revision for bleeding were independent risk factors for PMV following cardiac surgery with CPB
Summary
We initially aimed to investigate the major predictive factors for prolonged mechanical ventilation (PMV) following cardiac surgery with cardiopulmonary bypass (CPB) in our center and, secondarily, we tried to find out the effects of the independent factors on mortality. Ventilator dependence following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality[2,3]. According to a worldwide meta-analysis, previous studies accepted very different time thresholds such as 6 hours or 21 days after operation[7,8]. Prolonged mechanical ventilation (PMV) after cardiac surgery is a significant financial burden for the hospital due to the long ICU stay and hospitalization duration. The substantial part of patients with PMV requires tracheostomy, long ICU care and, much longer hospital stay and need for recurrent hospitalization[9]
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