Postoperative acute respiratory failure in cardiac surgery

Area of Science:

• Cardiology
• Pulmonology
• Critical Care Medicine

Background:

• Postoperative acute respiratory failure (ARF) is a significant complication following cardiac and aortic surgery.
• Understanding the incidence, causes, and outcomes of ARF is crucial for improving patient management.

Purpose of the Study:

• To evaluate the incidence, causes, and outcomes of acute respiratory failure (ARF) in patients undergoing cardiac and aortic surgery.
• To identify risk factors and mortality associated with ARF in this patient population.

Main Methods:

• Retrospective analysis of 3972 patients undergoing elective cardiovascular procedures between 2013 and 2017.
• Inclusion criteria included a sustained reduction in pulmonary function (PaO2/FiO2 < 300 mm Hg) requiring mechanical or non-invasive ventilation for at least 24 hours postoperatively.

Main Results:

• ARF developed in 3.5% of patients, with a higher incidence after aortic surgery (11.2%).
• Acute respiratory distress syndrome (ARDS) was the leading cause of ARF (26.8%), followed by neurological complications (18.1%), and COPD/asthma exacerbations (16.1%).
• Overall ARDS-associated mortality was 21.6%, with severe ARDS having a 75% mortality rate. Nosocomial pneumonia occurred in 40.6% but was not fatal.

Conclusions:

• ARF is a significant complication in cardiac and aortic surgery patients, with ARDS being the main driver of mortality.
• Incidence of ARF was lower after off-pump coronary artery bypass surgery compared to on-pump procedures.
• While nosocomial pneumonia was common, it did not lead to fatalities in this cohort.