A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery

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• 作者：Vivek Sharma ; MD ; FRCA^a ; ^{docvvs@yahoo.co.in} ; Vivek Rao ; MD ; PhD ; FRCSC ; FACS^b ; Cedric Manlhiot ; PhD^c ; Audrey Boruvka ; PhD^c ; Stephen Fremes ; MD ; FRCSC^d ; Marcin Wąsowicz ; MD ; PhD ; FRCPC^a
• 关键词：prolonged mechanical ventilation ; cardiac surgery ; validated model
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：153
• 期：1
• 页码：108-115
• 全文大小：538 K
• 卷排序：153

文摘

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.MethodsWe 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.ResultsProlonged 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.ConclusionsProlonged mechanical ventilation after cardiac surgery can be accurately predicted by readily available pre- and intraoperative information.