CLINICAL FACTORS ASSOCIATED WITH POSTOPERATIVE LENGTH OF TIME ON VENTILATOR AMONG CORONARY ARTERY GRAFT SURGERY PATIENTS

Authors

  • Annapoorna Mary Loewenberg School of Nursing 2M.D., M.P.H., Ph.D., Assistant Professor of Epidemiology and Biostatistics The University of Memphis
  • Fawaz Mzayek Loewenberg School of Nursing 2M.D., M.P.H., Ph.D., Assistant Professor of Epidemiology and Biostatistics The University of Memphis

Abstract

Background:Very little is known about the optimum required length of time on ventilator after CABG surgery. Further there are inconsistencies in the practice of ventilator weaning criteria after CABG surgery. Identification of factors associated with ventilator weaning recovery may help to promote patient safety and quality care after CABG surgery.

Objectives:The purposes of this secondary analysis were to identify the factors associated with the length of time on ventilator and to determine the factors associated with the prolonged mechanical ventilator more than 8 hours.

Materials and Methods: Secondary analysis of a case control primary study data

Results:The results of this secondary analysis revealed the factors associated with the length of time on the ventilator including Age, Sex, COPD, and CHF. Among patients with a history of COPD, 29.1% remained > 8 hours on the ventilator compared to 67.7% among those without COPD (COPD: p< 0.001, Cramer’s V = 0.25). Among patients with a history of CHF 75% remained on the ventilator > 8 hours compared to 31% among those without CHF (p = 0.01 and Cramer’s V = 0.21).

Conclusion:These associations remained significant after adjusting for age, sex, number of grafts and body surface area. Based on the above findings, this analysis concludes that ventilator weaning outcomes should be closely monitored, while implementing weaning protocols for patients with diagnosis of COPD, and CHF co morbid conditions after CABG surgery.

Key Words: Ventilator Weaning, CABG surgery, Postoperative Ventilator Time, Clinical factors

References

Currey, J. and M. Botti, Naturalistic decision making: a model to overcome methodological challenges in the study of critical care nurses' decision making about patients' hemodynamic status. Am J Crit Care, 2003. 12(3): p. 206-11.

Thelan, critical care nursing diagnosis and management. third edition ed. Vol. 1998, philadelphis: mosby.

Celkan, M.A., et al., Readmission and mortality in patients undergoing off-pump coronary artery bypass surgery with fast-track recovery protocol. Heart Vessels, 2005. 20(6): p. 251-5.

Serrano, N., et al., Prolonged intubation rates after coronary artery bypass surgery and ICU risk stratification score. Chest, 2005. 128(2): p. 595-601.

Myles, P.S. and D. McIlroy, Fast-track cardiac anesthesia: choice of anesthetic agents and techniques. Semin Cardiothorac Vasc Anesth, 2005. 9(1): p. 5-16.

Watanabe, Y., et al., [Fast-track cardiac anesthesia and perioperative management appropriate for early rehabilitation after coronary artery bypass graft (CABG) surgery]. Masui, 2004. 53(8): p. 898-902.

Roediger, L., et al., [New anesthetic and resuscitation techniques in adult cardiac surgery]. Rev Med Liege, 2004. 59(1): p. 35-45.

Brucek, P.J., et al., Less invasive cardiac anesthesia: an ultra-fast-track procedure avoiding thoracic epidural analgesia. Heart Surg Forum, 2003. 6(6): p. E107-10.

Murphy, G.S., et al., Recovery of neuromuscular function after cardiac surgery: pancuronium versus rocuronium. Anesth Analg, 2003. 96(5): p. 1301-7, table of contents.

Bowler, I., et al., A combination of intrathecal morphine and remifentanil anesthesia for fast-track cardiac anesthesia and surgery. J Cardiothorac Vasc Anesth, 2002. 16(6): p. 709-14.

Reis, J., et al., Early extubation does not increase complication rates after coronary artery bypass graft surgery with cardiopulmonary bypass. Eur J Cardiothorac Surg, 2002. 21(6): p. 1026-30.

Cheng, D.C., et al., The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial. Anesth Analg, 2001. 92(5): p. 1094-102.

Howie, M.B., et al., A randomized double-blinded multicenter comparison of remifentanil versus fentanyl when combined with isoflurane/propofol for early extubation in coronary artery bypass graft surgery. Anesth Analg, 2001. 92(5): p. 1084-93.

Capdeville, M., J.H. Lee, and A.L. Taylor, Effect of gender on fast-track recovery after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2001. 15(2): p. 146-51.

Montes, F.R., et al., The lack of benefit of tracheal extubation in the operating room after coronary artery bypass surgery. Anesth Analg, 2000. 91(4): p. 776-80.

Royston, D., Patient selection and anesthetic management for early extubation and hospital discharge: CABG. J Cardiothorac Vasc Anesth, 1998. 12(6 Suppl 2): p. 11-9.

Silbert, B.S., et al., Early extubation following coronary artery bypass surgery: a prospective randomized controlled trial. The Fast Track Cardiac Care Team. Chest, 1998. 113(6): p. 1481-8.

Yende, S. and R. Wunderink, Validity of scoring systems to predict risk of prolonged mechanical ventilation after coronary artery bypass graft surgery. Chest, 2002. 122(1): p. 239-44.

Troche, G. and P. Moine, Is the duration of mechanical ventilation predictable? Chest, 1997. 112(3): p. 745-51.

Schonhofer, B., Predictors of weanability. Monaldi Arch Chest Dis, 2000. 55(4): p. 339-44.

Saldias, F., et al., [Predictor indices of early extubation in mechanical ventilation in patients treated with heart surgery]. Rev Med Chil, 1996. 124(8): p. 959-66.

Capdevila, X.J., et al., Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. Chest, 1995. 108(2): p. 482-9.

Kollef, M.H., et al., A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med, 1997. 25(4): p. 567-74.

de Souza, R.L. and W.B. de Carvalho, [Preliminary study about the utility of gastric tonometry during the weaning from mechanical ventilation]. Rev Assoc Med Bras, 2002. 48(1): p. 66-72.

Frazier, S.K., et al., A comparison of hemodynamic changes during the transition from mechanical ventilation to T-piece, pressure support, and continuous positive airway pressure in canines. Biol Res Nurs, 2000. 1(4): p. 253-64.

Hurst, J.M., et al., Cardiopulmonary effects of pressure support ventilation. Arch Surg, 1989. 124(9): p. 1067-70.

Savino, J.S., et al., Practice pattern variability for myocardial revascularization: impact on resource use across 24 centers. J Cardiothorac Vasc Anesth, 2002. 16(2): p. 149-56.

Brum, G., et al., [Prolonged mechanical ventilation in a respiratory ICU]. Rev Port Pneumol, 2003. 9(5 Suppl): p. 27-8.

Chao, D.C., D.J. Scheinhorn, and M. Stearn-Hassenpflug, Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest, 1997. 112(6): p. 1592-9.

Chailleux, E., et al., Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR Observatory. Chest, 1996. 109(3): p. 741-9.

Shang, M., et al., Changes in respiratory and circulatory functions during sequential invasive-noninvasive mechanical ventilation. Chin Med J (Engl), 2003. 116(8): p. 1253-6.

Shang, M., C. Wang, and H. Dai, [Changes in respiratory and circulatory function during sequential invasive-noninvasive mechanical ventilation]. Zhonghua Jie He He Hu Xi Za Zhi, 2001. 24(8): p. 487-9.

Meade, M.O., G.H. Guyatt, and D.J. Cook, Weaning from mechanical ventilation: the evidence from clinical research. Respir Care, 2001. 46(12): p. 1408-15; discussion 1415-7.

Epstein, C.D., N. El-Mokadem, and J.R. Peerless, Weaning older patients from long-term mechanical ventilation: a pilot study. Am J Crit Care, 2002. 11(4): p. 369-77.

Nichols, J.D., et al., Effects of increasing FiO2 on venous saturation during cardiopulmonary bypass in the swine model. J Extra Corpor Technol, 2002. 34(2): p. 118-24.

Sulzer, C.F., et al., Adaptive support ventilation for fast tracheal extubation after cardiac surgery: a randomized controlled study. Anesthesiology, 2001. 95(6): p. 1339-45.

Epstein, S.K., M.L. Nevins, and J. Chung, Effect of unplanned extubation on outcome of mechanical ventilation. Am J Respir Crit Care Med, 2000. 161(6): p. 1912-6.

Epstein, S.K., R.L. Ciubotaru, and J.B. Wong, Effect of failed extubation on the outcome of mechanical ventilation. Chest, 1997. 112(1): p. 186-92.

Epstein, S.K. and R.L. Ciubotaru, Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation. Am J Respir Crit Care Med, 1998. 158(2): p. 489-93.

Epstein, S.K., Extubation failure: an outcome to be avoided. Crit Care, 2004. 8(5): p. 310-2.

Epstein, S.K., Decision to extubate. Intensive Care Med, 2002. 28(5): p. 535-46.

Epstein, S.K., Weaning from mechanical ventilation. Respir Care, 2002. 47(4): p. 454-66; discussion 466-8.

Epstein, S.K., Predicting extubation failure: is it in (on) the cards? Chest, 2001. 120(4): p. 1061-3.

Epstein, S.K., Etiology of extubation failure and the predictive value of the rapid shallow breathing index. Am J Respir Crit Care Med, 1995. 152(2): p. 545-9.

Smyrnios, N.A., et al., Effects of a multifaceted, multidisciplinary, hospital-wide quality improvement program on weaning from mechanical ventilation. Crit Care Med, 2002. 30(6): p. 1224-30.

Chhabra, S.K. and S. De, Cardiovascular autonomic neuropathy in chronic obstructive pulmonary disease. Respir Med, 2005. 99(1): p. 126-33.

Georgopoulos, D., et al., Effects of breathing patterns on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation. Intensive Care Med, 1995. 21(11): p. 880-6.

Anand, I.S., et al., Pathogenesis of congestive state in chronic obstructive pulmonary disease. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery. Circulation, 1992. 86(1): p. 12-21.

Butler, J., et al., Cause of the raised wedge pressure on exercise in chronic obstructive pulmonary disease. Am Rev Respir Dis, 1988. 138(2): p. 350-4.

Boldt, J. and G. Hempelmann, [Hemodynamic effects of enoximone--comparative studies of heart surgery patients]. Z Kardiol, 1991. 80 Suppl 4: p. 41-6.

Gel'tser, B.I. and M.V. Frisman, [Assessment of the quality of life of cardiological patients: current approach]. Klin Med (Mosk), 2002. 80(9): p. 4-9.

Kavarana, M.N., et al., Right ventricular dysfunction and organ failure in left ventricular assist device recipients: a continuing problem. Ann Thorac Surg, 2002. 73(3): p. 745-50.

Binkley, P.F., et al., Dissociation between ACE activity and autonomic response to ACE inhibition in patients with heart failure. Am Heart J, 2000. 140(1): p. 34-42.

Guerin, A.P., et al., Cardiovascular disease in renal failure. Minerva Urol Nefrol, 2004. 56(3): p. 279-88.

Alpert, M.A., Cardiac performance and morphology in end-stage renal disease. Am J Med Sci, 2003. 325(4): p. 168-78.

London, G.M., Left ventricular alterations and end-stage renal disease. Nephrol Dial Transplant, 2002. 17 Suppl 1: p. 29-36.

Schafer, G.E., et al., Renal anemia and its hemodynamic response--findings invasively determined over a period of 20 years. Clin Nephrol, 2002. 58 Suppl 1: p. S52-7.

Amabile, N., et al., Circulating endothelial microparticles are associated with vascular dysfunction in patients with end-stage renal failure. J Am Soc Nephrol, 2005. 16(11): p. 3381-8.

Rundback, J.H., et al., Chronic renal ischemia: pathophysiologic mechanisms of cardiovascular and renal disease. J Vasc Interv Radiol, 2002. 13(11): p. 1085-92.

Zhou, X., L. Matavelli, and E.D. Frohlich, Uric acid: its relationship to renal hemodynamics and the renal renin-angiotensin system. Curr Hypertens Rep, 2006. 8(2): p. 120-4.

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Published

2016-04-20