A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery
A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery
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DOI：
10.1016/j.jtcvs.2016.08.020
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发表时间：
2017-01-01
影响因子：
6
通讯作者：
Wasowicz, Marcin
中科院分区：
文献类型：
--
作者：
Sharma, Vivek;Rao, Vivek;Wasowicz, Marcin
目的：心脏手术后长时间的机械通气在发病率以及医院的经济负担方面给患者带来了重大负担。我们进行了一项回顾性分析2前瞻性收集的数据库开发的三级心脏护理中心，推导和验证的风险指数预测长期机械通气后心脏surgery.Methods：我们研究了一个回顾性队列的32,045例患者接受心脏手术，在2家医院在多伦多，加拿大。开发队列包括多伦多总医院的21，661例患者。数据Sunnybrook健康科学中心，多伦多，加拿大，10,384例患者，作为一个机构验证队列。我们操作的特点是延长机械通气的持续时间从手术完成拔管超过48 hours.Results：延长术后机械通气率的发展和验证队列分别为6%和7%。多变量回归分析显示，以下因素是心脏手术后机械通气时间延长的强预测因素：既往心脏手术、左心室射血分数降低、休克、先天性心脏病修复手术和体外循环时间。术中多变量模型在验证队列中保持了良好的区分度，达到0.787的c统计量。结论：通过术前和术中的信息，可以准确预测心脏手术后长期机械通气。
Objectives: Prolonged mechanical ventilation after cardiac surgery imposes a significant burden on the patient in terms of morbidity as well as a financial burden on the hospital. We undertook a retrospective analysis of 2 prospectively collected databases developed in tertiary cardiac care centers to derive and validate a risk index predicting prolonged mechanical ventilation after cardiac surgery.Methods: We studied a retrospective cohort of 32,045 patients undergoing cardiac surgery in 2 hospitals in Toronto, Canada. The development cohort consisted of 21,661 patients at Toronto General Hospital. Data Sunnybrook Health Sciences Centre, Toronto, Canada, with 10,384 patients, served as an institutional validation cohort. We operationally characterized prolonged mechanical ventilation as the duration from surgery completion to extubation exceeding 48 hours.Results: Prolonged postoperative mechanical ventilation rates in the development and validation cohort were 6% and 7%, respectively. Multivariable regression in the development cohort showed that the following factors were strong predictors of prolonged mechanical ventilation after cardiac surgery: previous cardiac surgery, lower left ventricular ejection fraction, shock, surgery involving repair of congenital heart disease, and cardiopulmonary bypass time. The intraoperative multivariable model retained good discrimination in the validation cohort, achieving a c statistic of 0.787.Conclusions: Prolonged mechanical ventilation after cardiac surgery can be accurately predicted by readily available pre- and intraoperative information.