Document Detail


Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery.
MedLine Citation:
PMID:  10075059     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To determine perioperative predictors of extubation failure (requirement for reintubation and mechanical ventilation after prior successful weaning from ventilator support and extubation) after cardiac surgery and the effect on clinical outcome. DESIGN: Cohort study. SETTING: A tertiary-care, 54-bed, cardiothoracic intensive care unit (ICU). PATIENTS: ICU admissions (n = 11,330) after cardiac surgery over a 42-month period. INTERVENTIONS: Collection of preoperative, operative, and ICU data from a database. MEASUREMENTS AND MAIN RESULTS: Frequency of extubation failure, total duration of mechanical ventilation, length of stay in ICU and hospital, and death. There were 748 (6.6%) patients who were weaned from mechanical ventilation after cardiac surgery and required reintubation and ventilator support. The predictors of extubation failure were: age of > or =65 yrs; inpatient hospitalization before surgery; arterial vascular disease; chronic obstructive pulmonary disease; pulmonary hypertension; severe left ventricular dysfunction; cardiac shock; hematocrit of < or =34%; blood urea nitrogen of > or =24 mg/dL; serum albumin concentration of < or =4.0 g/dL (< or =40.0 g/ L); systemic oxygen delivery of < or =320 mL/min/m2; redo operation; surgical procedures involving the thoracic aorta; transfusion of blood products of > or =10 units; and cardiopulmonary bypass time of > or =120 mins. Extubation failure prolonged the length of total mechanical ventilation, as well as ICU and hospital stay, independent of the frequency of organ dysfunction or nosocomial infections but did not increase the risk of death after cardiac surgery. CONCLUSIONS: Extubation failure after cardiac surgery is uncommon. Although extubation failure increased the utilization of ICU and hospital resources, it did not affect mortality after cardiac surgery. Protocols for early extubation and ICU discharge should be modified in the presence of certain preoperative and operative predictors of extubation failure to avoid unnecessary increase in the cost of care after cardiac surgery.
Authors:
M Y Rady; T Ryan
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Critical care medicine     Volume:  27     ISSN:  0090-3493     ISO Abbreviation:  Crit. Care Med.     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-03-29     Completed Date:  1999-03-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  340-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Critical Care Medicine, Mayo Clinic Scottsdale, AZ 85259, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Surgical Procedures* / statistics & numerical data
Chi-Square Distribution
Cohort Studies
Databases, Factual
Female
Humans
Logistic Models
Male
Middle Aged
Postoperative Care / statistics & numerical data
Prognosis
ROC Curve
Risk Factors
Statistics, Nonparametric
Treatment Failure
Treatment Outcome
Ventilator Weaning* / methods,  statistics & numerical data
Comments/Corrections
Comment In:
Crit Care Med. 1999 Feb;27(2):246-7   [PMID:  10075037 ]
Crit Care Med. 2000 Jun;28(6):2181-2   [PMID:  10890711 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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