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Ventilatory dependency after cardiovascular surgery.

Sudish C Murthy1, Alejandro C Arroliga, Peter A Walts

  • 1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. murthys1@ccf.org

The Journal of Thoracic and Cardiovascular Surgery
|July 31, 2007
PubMed
Summary
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Cardiovascular surgery patients with poor hemodynamic status and early complications are at high risk for prolonged mechanical ventilation. Tracheostomy in these patients significantly worsens survival outcomes.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Ventilatory dependency is a common complication after cardiovascular surgery, often necessitating tracheostomy.
  • While risk factors for ventilatory dependency are known, short- and long-term outcomes remain less characterized.

Purpose of the Study:

  • Identify risk factors for developing ventilatory dependency post-cardiovascular surgery.
  • Assess the short- and long-term outcomes associated with ventilatory dependency.
  • Determine the impact of tracheostomy on patient outcomes.

Main Methods:

  • Retrospective analysis of 12,777 patients undergoing cardiovascular surgery (1998-2001).
  • Identified 704 patients (5.5%) with ventilatory dependency (>72 hours intubation).

Related Experiment Videos

  • Utilized preoperative, intraoperative, and ICU data for predictor analysis; employed time-related methods and competing-risks analysis for outcomes and tracheostomy impact.

    • Main Results:

    • Hemodynamic status (low cardiac output, vasopressor use, pulmonary hypertension) and early postoperative events (stroke, bacteremia) were key predictors of ventilatory dependency.
    • Survival rates at 30 days, 1 year, and 5 years were 76%, 49%, and 33%, strongly linked to favorable hemodynamics.
    • Tracheostomy (performed in 24% of dependent patients) was associated with significantly lower 30-day (74%) and 2-year (26%) survival compared to anticipated rates.

    Conclusions:

    • Improving perioperative strategies to maintain myocardial function and hemodynamics is crucial to reduce ventilatory dependency.
    • Current preoperative models are insufficient for predicting ventilatory dependency.
    • Outcomes following tracheostomy are poorly predicted, indicating complex pre- and post-procedure factors.