Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China.
Risk Factors for Prolonged Mechanical Ventilation After Pulmonary Endarterectomy: 7 Years' Experience From an Experienced Hospital in China.
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DOI：
10.3389/fsurg.2021.679273
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发表时间：
2021
影响因子：
1.8
通讯作者：
Wang G
中科院分区：
文献类型：
--
作者：
Zhang C;Yang L;Shi S;Fang Z;Li J;Wang G
背景资料：长期机械通气（PMV）是常见的心胸外科手术后，而肺动脉内膜切除术（PEA）后的机械通气策略尚未报道。我们的目的是确定PMV的发病率和危险因素以及PMV与短期结局之间的关系。方法：我们对2014年至2020年接受PEA手术的171例患者进行了回顾性队列研究。采用限制性三次样条进行考克斯回归，以确定PMV的截止值。应用最小绝对收缩法、选择算子回归和Logistic回归分析PMV的危险因素。评价PMV对近期疗效的影响。结果：PMV定义为机械通气时间超过48 h。PMV的独立危险因素包括女性（OR 2.911; 95%CI 1.303-6.501; P = 0.009），延长深低温停循环（DHCA）时间（OR 1.027; 95% CI 1.002-1.053; P = 0.036），术后血液制品使用增加（OR 3.542; 95% CI 1.203-10.423; P = 0.022），术后总胆红素水平升高（OR 1.021; 95% CI 1.007-1.034; P = 0.002），术前肺动脉压（PAP）升高（OR 1.031; 95% CI 1.014-1.048; P < 0.001）和术后右心室前后径（RVAD）延长（OR 1.119; 95% CI 1.026-1.221; P = 0.011）。PMV患者的重症监护时间较长，术后并发症发生率较高，住院医疗费用较高。结论：女性、DHCA时间延长、术后血液制品使用增加、术后总胆红素水平升高、术前PAP升高和术后RVAD延长是PMV的独立危险因素。在接受PEA的患者中识别与PMV相关的风险因素可能有助于及时诊断和重新干预其中一些可改变的因素，以减少通气时间并改善患者结局。
Background: Prolonged mechanical ventilation (PMV) is common after cardiothoracic surgery, whereas the mechanical ventilation strategy after pulmonary endarterectomy (PEA) has not yet been reported. We aim to identify the incidence and risk factors for PMV and the relationship between PMV and short-term outcomes. Methods: We studied a retrospective cohort of 171 who undergoing PEA surgery from 2014 to 2020. Cox regression with restricted cubic splines was performed to identify the cutoff value for PMV. The Least absolute shrinkage and selection operator regression and logistic regressions were applied to identify risk factors for PMV. The impacts of PMV on the short-term outcomes were evaluated. Results: PMV was defined as the duration of mechanical ventilation exceeding 48 h. Independent risk factors for PMV included female sex (OR 2.911; 95% CI 1.303–6.501; P = 0.009), prolonged deep hypothermic circulatory arrest (DHCA) time (OR 1.027; 95% CI 1.002–1.053; P = 0.036), increased postoperative blood product use (OR 3.542; 95% CI 1.203–10.423; P = 0.022), elevated postoperative total bilirubin levels (OR 1.021; 95% CI 1.007–1.034; P = 0.002), increased preoperative pulmonary artery pressure (PAP) (OR 1.031; 95% CI 1.014–1.048; P < 0.001) and elongated postoperative right ventricular anteroposterior dimension (RVAD) (OR 1.119; 95% CI 1.026–1.221; P = 0.011). Patients with PMV had longer intensive care unit stays, higher incidences of postoperative complications, and higher in-hospital medical expenses. Conclusions: Female sex, prolonged DHCA time, increased postoperative blood product use, elevated postoperative total bilirubin levels, increased preoperative PAP, and elongated postoperative RVAD were independent risk factors for PMV. Identification of risk factors associated with PMV in patients undergoing PEA may facilitate timely diagnosis and re-intervention for some of these modifiable factors to decrease ventilation time and improve patient outcomes.
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影响因子：
2
作者：
DURRLEMAN, S;SIMON, R
通讯作者：
SIMON, R
影响因子：
--
作者：
Grignola JC;Domingo E
通讯作者：
Domingo E
DOI：
10.1053/j.jvca.2008.09.006
发表时间：
2009-08-01
影响因子：
2.8
作者：
Lei, Qian;Chen, Lei;Li, Lihuan
通讯作者：
Li, Lihuan
DOI：
10.1053/j.jvca.2014.09.002
发表时间：
2015-02-01
影响因子：
2.8
作者：
Gumus, Funda;Polat, Adil;Alagol, Aysin
通讯作者：
Alagol, Aysin
影响因子：
8.3
作者：
Madani, Michael;Mayer, Eckhard;Jenkins, David P.
通讯作者：
Jenkins, David P.