Predictors of prolonged mechanical ventilation after open heart surgery.
Predictors of prolonged mechanical ventilation after open heart surgery.
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DOI：
10.15171/jcvtr.2014.014
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发表时间：
2014
影响因子：
1.1
通讯作者：
Chitsazan M
中科院分区：
文献类型：
--
作者：
Totonchi Z;Baazm F;Chitsazan M;Seifi S;Chitsazan M
简介：由于长期机械通气（PMV）作为术后并发症的重要性，通过识别诱发风险因素来预测“高危”患者是一个重要问题。本研究旨在确定心脏直视手术患者围手术期与PMV相关的变量。 研究方法：本观察性研究共纳入了743例连续患者，美国麻醉医师协会（ASA）身体状态III级，计划接受体外循环心脏直视手术。比较有和无PMV患者的围手术期变量，PMV定义为拔管时间> 48 h。 结果：45例（6.1%）患者发生PMV。在单因素分析中，术前变量;包括性别、慢性阻塞性肺疾病（COPD）病史;慢性肾脏疾病和心内膜炎;术中变量;包括手术类型、手术时间、泵时间、手术室输血和术后变量;包括出血和收缩力依赖性在有和无PMV的患者之间有显著差异（除COPD和手术室输血外，P均<0.001;分别为P = 0.004和P = 0.017）。 结论：我们的研究结果强调，预测延迟拔管的危险分层应该是所有麻醉学设置术前临床评估的一个重要方面。
Introduction: Due to the importance of prolonged mechanical ventilation (PMV) as a postoperative complication, predicting "high-risk" patients by identifying predisposing risk factors is of important issue. The present study was aimed to identify perioperative variables associated with PMV in patients undergoing open heart surgery. Methods: A total of 743 consecutive patients, American Society of Anesthesiologists (ASA) physical status class III, who were scheduled to undergo open heart surgery using cardiopulmonary bypass were included in this observational study. Perioperative variables were compared between the patients with and without PMV, as defined by an extubation time of >48 h. Results: PMV occurred in 45 (6.1%) patients. On univariate analysis, pre-operative variables; including gender, history of chronic obstructive pulmonary disease (COPD); chronic kidney disease and endocarditis, intra-operative variables; including type of surgery, operation time, pump time, transfusion in operating room and postoperative variables; including bleeding and inotrope-dependency were significantly different between patients with and without PMV (all P<0.001, except for COPD and transfusion in operating room; P=0.004 and P=0.017, respectively). Conclusion: Our findings reinforce that risk stratification for predicting delayed extubation should be an important aspect of preoperative clinical evaluation in all anesthesiology settings.