Document Detail


Earlier Versus Later Tracheostomy in Patients With Respiratory Failure After Cardiac Surgery in the United States.
MedLine Citation:
PMID:  24295717     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: The objective of this study was to evaluate the impact of timing of tracheostomy on outcomes of patients with respiratory failure after cardiac surgery.
DESIGN: Retrospective analysis of national database.
SETTING: United States hospitals.
PARTICIPANTS: A weighted estimate of 2,063,227 patients (475,773 case records) undergoing cardiac surgery identified from the Nationwide Inpatient Sample between 2002-2010 INTERVENTIONS: Early versus late tracheostomy.
MEASUREMENTS AND MAIN RESULTS: The incidence of postoperative respiratory failure was 7.8%. The strongest independent predictors of respiratory failure included female gender (odds ratio [OR] 1.3, 95% confidence interval [CI] 1.28-1.31), age (OR 1.13 for each decade, 95% CI 1.12-1.13), chronic obstructive airways disease (OR 2.16, 95% CI 2.13-2.19), chronic renal insufficiency (OR 2.28, 95% CI 2.25-2.31), and valve surgery (OR 1.62, 95% CI 1.6-1.64). Tracheostomy was performed in 22.9% of patients with respiratory failure; 13.6% of tracheostomies were performed within 5 days of surgery (or within 5 days of intubation in patients who underwent reintubation), and 20.5% were performed on postoperative day 21 or later. Compared with tracheostomy performed within 5 days of intubation, there was a near-stepwise increase in risk of mortality with delayed tracheostomy performed between days 11-15 (OR 1.29, 95% CI 1.16-1.43), days 16-20 (OR 1.25, 95% CI 1.11-1.41), and day 21 or later (OR 1.53, 95% CI 1.37-1.71).
CONCLUSIONS: In this analysis of outcomes of patients with respiratory failure after cardiac surgery in the United States, deferring tracheostomy did not appear to improve patient outcomes after cardiac surgery.
Authors:
Leila Hosseinian; Yuting Chiang; Shinobu Itagaki; Antonio Polanco; Amanda Rhee; Joanna Chikwe
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-11-29
Journal Detail:
Title:  Journal of cardiothoracic and vascular anesthesia     Volume:  -     ISSN:  1532-8422     ISO Abbreviation:  J. Cardiothorac. Vasc. Anesth.     Publication Date:  2013 Nov 
Date Detail:
Created Date:  2013-12-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9110208     Medline TA:  J Cardiothorac Vasc Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013. Published by Elsevier Inc.
Affiliation:
Anesthesiology.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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