Abstract
ObjectivesThe aim of this study was to determine the effects of escalation of respiratory support and prolonged postoperative invasive ventilation on patient-centered outcomes, and identify perioperative factors associated with these 2 respiratory complications.DesignA retrospective cohort analysis of cardiac surgical patients admitted to the cardiothoracic intensive care unit (ICU) between August 2015 and January 2018. Escalation of respiratory support was defined as “unplanned continuous positive airway pressure,” “non-invasive ventilation,” or “reintubation” after surgery; prolonged invasive ventilation was defined as “invasive ventilation beyond the first 12 hours following surgery.” The primary endpoint was the composite of escalation of respiratory support and prolonged ventilation.SettingTertiary cardiothoracic ICU.ParticipantsA total of 2,098 patients were included and analyzed.InterventionsNone.Measurements and Main ResultsThe composite of escalation of support or prolonged ventilation occurred in 509 patients (24.3%). Patients who met the composite had higher mortality (2.9% v 0.1%; p < 0.001) and longer median [interquartile range] length of ICU (2.1 [1.0-4.9] v 0.9 [0.8-1.0] days; p < 0.0001) and hospital (10.6 [8.0-16.0] v 7.2 [6.2-10.0] days; p < 0.0001) stay. Hypoxemia and anemia on admission to ICU were the only 2 factors independently associated with the need for escalation of respiratory support or prolonged invasive ventilation.ConclusionsEscalation of respiratory support or prolonged invasive ventilation is frequently seen in cardiac surgery patients and is highly associated with increased mortality and morbidity. Hypoxemia and anemia on admission to the ICU are potentially modifiable factors associated with escalation of respiratory support or prolonged invasive ventilation.
Highlights
The aim of this study was to determine the effects of escalation of respiratory support and prolonged postoperative invasive ventilation on patient-centered outcomes, and identify perioperative factors associated with these 2 respiratory complications
The authors retrospectively examined a cohort of adult cardiac surgical patients who underwent elective cardiac surgery with cardiopulmonary bypass and were admitted to Royal Papworth Hospital National Health Service (NHS) Trust cardiothoracic intensive care unit (ICU) between August 2015 and January 2018
After adjusting for possible confounding factors, including EuroSCORE, cardiopulmonary bypass time, age, gender, body mass index, cross-clamp time, ICU admission hemoglobin level, admission arterial partial pressure of oxygen to inspired fraction of oxygen ratio, and type of surgery, there was a significant between-group difference in length of ICU stay, hospital length of stay, and in-hospital mortality (2.9% v 0.1%; p < 0.001)
Summary
The aim of this study was to determine the effects of escalation of respiratory support and prolonged postoperative invasive ventilation on patient-centered outcomes, and identify perioperative factors associated with these 2 respiratory complications. Design: A retrospective cohort analysis of cardiac surgical patients admitted to the cardiothoracic intensive care unit (ICU) between August 2015 and January 2018. The primary endpoint was the composite of escalation of respiratory support and prolonged ventilation. Measurements and Main Results: The composite of escalation of support or prolonged ventilation occurred in 509 patients (24.3%). Patients who met the composite had higher mortality (2.9% v 0.1%; p < 0.001) and longer median [interquartile range] length of ICU
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