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Morbid results of prolonged intubation after coronary artery bypass surgery
A J Cohen1, M G Katz, G Frenkel
1Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Israel. sally@wolfson.health.gov.il
Insights
Prolonged intubation after coronary artery bypass grafting (CABG) is linked to increased morbidity and mortality. Factors like reduced lung function and renal issues predict this risk, emphasizing the need for careful patient management.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Respiratory Medicine
Background:
- Prolonged intubation following coronary artery bypass grafting (CABG) is a significant concern.
- Identifying predictors and outcomes of prolonged intubation is crucial for improving patient care.
Purpose of the Study:
- To evaluate the morbid outcomes associated with prolonged intubation after CABG.
- To identify predictors of prolonged intubation in CABG patients.
- To compare postoperative courses among different intubation management groups.
Main Methods:
- A retrospective study of 1,112 patients undergoing CABG over 30 months.
- Matched 66 patients with prolonged intubation to 66 without.
- Analyzed preoperative and operative variables, and divided patients into early extubation with reintubation, initial prolonged intubation without reintubation, and initial prolonged intubation with reintubation groups.
Main Results:
- Predictors of prolonged intubation included unstable angina, elevated creatinine, reduced forced expiratory volume in 1 second (FEV1), longer cardiopulmonary bypass time, and positive fluid balance.
- Elevated creatinine, reduced FEV1, and fluid balance were confirmed as independent predictors.
- Prolonged intubation was associated with longer ICU and hospital stays, increased infectious complications, and higher mortality.
Conclusions:
- Reduced FEV1, renal failure, and positive fluid balance are risk factors for prolonged intubation post-CABG.
- Prolonged intubation significantly increases acute and midterm morbidity and mortality.
- Early extubation followed by reintubation exacerbates these adverse outcomes.
Objectives:
This study evaluated the morbid results of prolonged intubation after coronary artery bypass grafting (CABG).
Methods:
Over 30 months, 66 of 1,112 patients undergoing CABG required prolonged intubation. They were matched with 66 patients who did not require prolonged intubation. Preoperative and operative variables were evaluated to determine which would predict prolonged intubation. The postoperative courses were then compared to evaluate the effect of prolonged intubation. The study population was divided into three groups: those who underwent early extubation, but required reintubation (n = 24); those who required initial prolonged intubation, but no reintubation (n = 22); and those who required initial prolonged intubation and reintubation (n = 20).
Results:
Univariate analysis revealed unstable angina (p = 0.037), elevated creatinine (p = 0.001), reduced FEV(1) (p = 0.019), longer cardiopulmonary bypass time (p = 0.009), and a greater positive fluid balance at 24 h (p = 0.0001) as predictors of postoperative prolonged intubation. Multivariate regression analysis revealed elevated creatinine (p = 0.011), FEV(1) (p = 0.022), and fluid balance (p = 0.001) as predictors of prolonged intubation. The study population had longer ICU and hospital stays (p = 0.0001), with more infectious complications (p = 0.0001) and higher mortality (p = 0. 001). In the subgroups of the study population, patients not requiring reintubation had shorter ICU (p = 0.001) and hospital stays (p = 0.0001), fewer infectious complications (p = 0.0001), and reduced mortality (p = 0.0001).
Conclusions:
Patients undergoing CABG with reduced FEV(1), renal failure, and positive fluid balance 24 h postoperatively are at risk for prolonged intubation. Prolonged intubation results in significant acute and midterm morbidity and mortality. Early extubation followed by reintubation further increases morbidity and mortality rates in these patients.