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Risk factors for endotracheal re-intubation following coronary artery bypass grafting
1Cardiovascular surgery department, Shanghai First People's Hospital, Shanghai Jiaotong University, 100 Haining Rd, Hongkou District, Shanghai 200080, China. yuanzhongxiangvip@163.com.
Insights
Re-intubation after coronary artery bypass grafting (CABG) is linked to several independent risk factors. Identifying these factors, including preoperative COPD and CHF, can improve patient outcomes and reduce mortality.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Pulmonary Medicine
Background:
- Endotracheal re-intubation post-coronary artery bypass grafting (CABG) is a significant concern, associated with increased morbidity and mortality.
- Limited research has identified independent risk factors contributing to re-intubation after CABG procedures.
Purpose of the Study:
- To identify and evaluate the independent risk factors associated with postoperative re-intubation in patients undergoing isolated CABG.
Main Methods:
- Retrospective analysis of pre-, intra-, and post-operative data from 1,244 patients who underwent isolated CABG between January 2004 and July 2012.
- Univariate analysis and logistic regression were employed to determine risk factors for postoperative re-intubation.
Main Results:
- The incidence of postoperative re-intubation was 7.8% (97 cases), with significantly higher in-hospital mortality (9.3% vs. 1.4%) compared to non-re-intubated patients.
- Re-intubation correlated with adverse outcomes including pneumonia, tracheotomy, acute renal failure, prolonged mechanical ventilation, and extended ICU and hospital stays.
- Key independent risk factors identified were: preoperative chronic obstructive pulmonary disease (COPD), preoperative congestive heart failure (CHF), postoperative relative hypoxemia, postoperative acute kidney injury (AKI), and prolonged postoperative mechanical ventilation time.
Conclusions:
- Preoperative COPD and CHF are significant risk factors for re-intubation following CABG.
- Postoperative relative hypoxemia, AKI, and extended mechanical ventilation duration independently increase the risk of re-intubation.
- Identifying these risk factors is crucial for developing targeted strategies to reduce re-intubation rates and improve patient outcomes after CABG.
Background:
Endotracheal re-intubation following coronary artery bypass grafting (CABG) is often associated with significant morbidity and mortality. However, few reports have focused on the independent risk factors for re-intubation following CABG. This study aimed to evaluate the independent risk factors for re-intubation following CABG.
Methods:
The pre-, intra-, and post-operative materials in patients who had selective and isolated CABG performed on them from January 2004 to July 2012 in our hospital were analyzed retrospectively. Unvariate analysis and logistic regression were used to analyze the risk factor of postoperative re-intubation following CABG.
Results:
Among the 1,244 patients investigated, 97 cases suffered from postoperative re-intubation, and the incidence rate of postoperative re-intubation was 7.8%. The in-hospital mortality in the re-intubation group was significantly higher than that in the non-re-intubation group (9.3% versus 1.4%, P = 0.004). Re-intubation also correlated with many negative outcomes such as pneumonia, tracheotomy, acute renal failure, infection of incision, prolonged mechanical ventilation time, prolonged intensive care unit (ICU) stay and prolonged hospital stay. The most commonly cause of re-intubation after CABG was hypoxemia due to cardiogenic and noncardiogenic disease, which accounted for 72.2%. The relative factors of postoperative re-intubation were tested through unvariate analysis and logistic regression, and the associated factors were obtained. The associated factors for re-intubation following CABG included preoperative chronic obstructive pulmonary disease (COPD) (OR = 2.134, 95% CI = 1.472-2.967), preoperative congestive heart failure (CHF) (OR = 2.325, 95% CI = 1.512-3.121), postoperative relative hypoxemia (OR = 2.743, 95% CI = 1.657-3.326), postoperative acute kidney injury (AKI) (OR = 2.976, 95% CI = 2.127-4.023), postoperative total mechanical ventilation time (OR = 1.976, 95% CI = 1.347-2.645).
Conclusion:
Preoperative COPD, preoperative CHF, postoperative relative hypoxemia, postoperative AKI and postoperative total mechanical ventilation time were five independent risk factors for re-intubation following CABG.
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