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Title: The Effects of Escalation of Respiratory Support and Prolonged Invasive Ventilation on Outcomes of Cardiac Surgical Patients: A Retrospective Cohort Study
Authors: Vasileios Zochios
Joht Singh Chandan
Marcus J. Schultz
Andrew Conway Morris
Ken Kuljit Parhar
Marc Giménez-Milà
Caroline Gerrard
Alain Vuylsteke
Andrew A. Klein
Papworth Hospital, NHS Foundation Trust
University of Cambridge
University of Birmingham
Addenbrooke's Hospital
Mahidol University
Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust
Hospital Universitari de Bellvitge
Glenfield Hospital
University of Calgary
Amsterdam UMC - University of Amsterdam
Keywords: Medicine
Issue Date: 1-May-2020
Citation: Journal of Cardiothoracic and Vascular Anesthesia. Vol.34, No.5 (2020), 1226-1234
Abstract: © 2019 The Authors Objectives: The aim of this study was to determine the effects of escalation of respiratory support and prolonged postoperative invasive ventilation on patient-centered outcomes, and identify perioperative factors associated with these 2 respiratory complications. Design: A retrospective cohort analysis of cardiac surgical patients admitted to the cardiothoracic intensive care unit (ICU) between August 2015 and January 2018. Escalation of respiratory support was defined as “unplanned continuous positive airway pressure,” “non-invasive ventilation,” or “reintubation” after surgery; prolonged invasive ventilation was defined as “invasive ventilation beyond the first 12 hours following surgery.” The primary endpoint was the composite of escalation of respiratory support and prolonged ventilation. Setting: Tertiary cardiothoracic ICU. Participants: A total of 2,098 patients were included and analyzed. Interventions: None. Measurements and Main Results: The composite of escalation of support or prolonged ventilation occurred in 509 patients (24.3%). Patients who met the composite had higher mortality (2.9% v 0.1%; p < 0.001) and longer median [interquartile range] length of ICU (2.1 [1.0-4.9] v 0.9 [0.8-1.0] days; p < 0.0001) and hospital (10.6 [8.0-16.0] v 7.2 [6.2-10.0] days; p < 0.0001) stay. Hypoxemia and anemia on admission to ICU were the only 2 factors independently associated with the need for escalation of respiratory support or prolonged invasive ventilation. Conclusions: Escalation of respiratory support or prolonged invasive ventilation is frequently seen in cardiac surgery patients and is highly associated with increased mortality and morbidity. Hypoxemia and anemia on admission to the ICU are potentially modifiable factors associated with escalation of respiratory support or prolonged invasive ventilation.
ISSN: 15328422
Appears in Collections:Scopus 2020

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