Progress of risk factor evaluation for prolonged mechanical ventilation after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MEI Xiang , XIA Yu ,  LIANG Guiyou

Department of Cardiovascular Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, 563003, Guizhou, P.R.China;

Corresponding author：

LIANG Guiyou, Email: guiyou515@163.com

Keywords：

Cardiopulmonary bypass; prolonged mechanical ventilation; risk factors; interventions

DOI：

10.7507/1007-4848.201801021

Video：

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Post operational recovery from cardiac surgery can be affected by many factors, including preoperative, intraoperative, and postoperative factors. Prolonged mechanical ventilation (PMV) , one of the major complications, has been widely accepted as a measure to evaluate the performance and outcomes of cardiac surgeries. Great progress has been made in the studies of risk factors contributing to PMV following cardiac surgeries in recent years. However, no clear and effective measures and approaches are available yet to prevent PMV. In this review, the authors try to summarize the risk factors that are associated with PMV throughout the perioperative period of cardiac surgery, as well as possible interventions when applicable.

Citation： MEI Xiang, XIA Yu, LIANG Guiyou. Progress of risk factor evaluation for prolonged mechanical ventilation after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(12): 1073-1079. doi: 10.7507/1007-4848.201801021 Copy

1.	Jacobs J, He X, Sean M, et al. Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database. Ann Thorac Surg, 2013, 96(3): 757-762.
2.	Hassan A, Anderson C, Kypson A, et al. Clinical outcome in patients with prolonged intensive care unit length of stay after cardiac surgical procedures. Ann Thorac Surg, 2012, 93(2): 565-569.
3.	Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
4.	孙静, 宋静华, 姜楠. 瓣膜置换术后机械通气时间延长的危险因素分析. 山东医药, 2012, 52(20): 36-38.
5.	龚书榕, 张颖蕊, 于荣国. 冠脉旁路移植术后患者延迟撤机的危险因素分析. 中国现代医学杂志, 2012, 22(9): 68-71.
6.	周峻峰, 韩丽丽, 万献尧. 体外循环术后患者延迟撤机的危险因素分析. 医学与哲学(临床决策论坛版), 2008, 12(29): 27-31.
7.	Szeles T, Yoshinaga E, Alencar W, et al. Hypoxemia after myocardial revascularization: analysis of risk factors. Rev Bras Anestesiol, 2008, 58(2): 124-136.
8.	Reddy S, Grayson A, Griffiths E, et al. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac Surg, 2007, 84: 528-536.
9.	Rajaei S, Dabbagh A. Risk factors for postoperative respiratory mortality and morbidity in patients undergoing coronary artery bypass grafting. Anesth Pain, 2012, 2(2): 60-65.
10.	Anghel D, Anghel R, Corciova F, et al. Preoperative arrhythmias such as atrial fibrillation: cardiovascular surgery risk factor. Biomed Res Int, 2014, 2014: 584918.
11.	Stephens R, Whitman G. Postoperative critical care of the adult cardiac surgical patient: Part II: Procedure-specific considerations, management of complications, and quality improvement. Crit Care Med, 2015, 43(9): 1995-2014.
12.	Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2016, 49: 5-17.
13.	Böning A, Buschbeck S, Roth P, et al. IABP before cardiac surgery: clinical benefit compared to intraoperative implantation. Perfusion, 2013, 28(2): 103-108.
14.	Yang F, Wang J, Hou D, et al. Peroperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients. Sci Rep, 2016, 6: 27645.
15.	Brown C, Joshi B, Faraday N, et al. Emergency cardiac surgery in patients with acute coronary syndromes: A review of the evidence and perioperative implications of medical and mechanical therapeutics. Anesth Analg, 2011, 112: 777-799.
16.	Bartz R, Ferreira R, Schroder J, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care, 2015, 30(5): 940-944.
17.	Knapik P, Ciesla D, Borowik D, et al. Prolonged ventilation post cardiac surgery- tips and pitfalls of the prediction game. J Cardiothorac Surg, 2011, 6: 158.
18.	Schechter M, Shah A, Englum B, et al. Prolonged postoperative respiratory support after proximal thoracic aortic surgery: Is deep hypothermic circulatory arrest a risk factor? J Crit Care, 2016, 31(1): 125-129.
19.	Lamy A, Devereaux P, Yusuf S. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2017, 376(9): 894-895.
20.	Santana O, Xydas S, Williams F, et al. Percutaneous coronary intervention followed by minimally invasive valve surgery compared with median sternotomy coronary artery bypass graft and valve surgery in patients with prior cardiac surgery. J Thorac Dis, 2017, 9(Suppl 7): S575-S581.
21.	吴春婷, 赵佳晖, 魏东, 等. 肺功能对合并慢性阻塞性肺疾病患者心脏外科手术预后的影响. 中华结核和呼吸杂志, 2017, 40(02): 86-89.43.
22.	Jian L, Sheng S, Min Y, et al. Risk factors for endotracheal re-intubation following coronary artery bypass grafting. J Cardiothorac Surg, 2013, 8: 208.
23.	Schechter M, Shah A, Englum B, et al. Prolonged postoperative respiratory support after proximal aortic surgery: Is deep hypothermic circulatory arrest a risk factor? J Crit Care, 2016, 31(1): 125-129.
24.	Saleh H, Mohan K, Shaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg, 2012, 42(1): 108-113.
25.	Giakoumidakis K, Eltheni R, Brokalaki H, et al. Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac surgery patients. Health Sci J, 2011, 5(4): 297-305.
26.	Hulzebos E, Helders P, Favie N, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery. JAMA, 2006, 296(15): 1851-1857.
27.	Thunberg C, Gaitan B, Grewal A, et al. Pulmonary hypertension in patients undergoing cardiac surgery: Pathophysiology, perioperative management, and outcomes. J Cardiothorac Vasc Anesth, 2013, 27(3): 551-572.
28.	Melby S, Moon M, Lindman B, et al. Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg, 2011, 141(6): 1424-1430.
29.	Chaudhry M, Omar A, Latif F. Impact of renal dysfunction and peripheral arterial disease on post-operative outcomes after coronary artery bypass grafting. Intech Open. Access Publisher, 2013.
30.	Ascione R, Nason G, Al-Ruzzeh S, et al. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative non-dialysis-dependent renal insufficiency. Ann Thorac Surg, 2001, 72(6): 2020-2025.
31.	Hur M, Koo H, Lee C, et al. Preoperative aspirin use and acute kidney injury after cardiac surgery: A propensity-score matched observational study. PloS One, 2017, 12(5): e0177201.
32.	WHO Technical Report Series 894. Obesity: Preventing and managing the global epidemic.2000.
33.	Ranucci M, Ballotta A, Teresa L, et al. Postoperative hyposia and length of intensive care unit stay after cardiac surgery: the underweight paradox? PLoS One, 2014, 9(4): e93992.
34.	Wigfield C, Lindsey J, Muñoz A, et al. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40. Eur J Cardiothorac Surg, 2006, 29: 434-440.
35.	Prabhakar G, Haan C, Peterson E, et al. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons’ database. Ann Thorac Surg, 2002, 74(4): 1125-1130.
36.	Straten A, Bramer S, Soliman M, et al. Effect of body mass index on early and late mortality after coronary artery bypass grafting. Ann Thoeacic Surg, 2010, 89: 30-37.
37.	Roman P, Grigore A. Pro: hypothermic cardiopulmonary bypass should be used routinely. J Cardiothorac Vasc Anesth, 2012, 26(5): 945-948.
38.	Loor G, Li L, Sabik J, et al. Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac Cardiovasc Surg, 2012, 144(3): 654-662.
39.	Ranucci M, Conti D, Castelvecchio S, et al. hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients. Ann Thorac Surg, 2010, 89(1): 11-17.
40.	Hori D, Nomura Y, Ono M, et al. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg, 2017, 154(5): 1590-1598.
41.	Ono M, Brady K, Easley R, et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg, 2014, 147(1): 483-489.
42.	Vlaar A, Hofstra J, Determann R, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study. Blood, 2011, 117(16): 4218-4225.
43.	McPherson J, Wagner C, Boehm L, et al. Delirium in the cardiovascular ICU: Exploring modifiable risk factors. Crit Care Med, 2013, 41(2): 405-413.
44.	Schoen J, Meyerrose J, Paarmann H, et al. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care, 2011, 15(5): R218.
45.	Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
46.	Shadvar K, Baastani F, Mahmoodpoor A, et al. Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU. J cardiovasc Thorac Res, 2013, 5(4): 157-161.
47.	He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6): 3148-3155.
48.	Lola I, Levidiotou S, Petrou A, et al. Are there independent predisposing factors for postoperative infections following open heart surgery? J Cardiothorac Surg, 2011, 6: 151.
49.	Craven D, Hudcova J, Lei Y, et al. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: " thinking outside the box”. Crit Care, 2016, 20(1): 300.
50.	Lellouche F, Dionne S, Simard S, et al. High tidal volumes in mechanically ventilation patients increase organ dysfunction after cardiac surgery. Anesthesiology, 2012, 116(5): 1072-1082.
51.	Lellouche F, Agrege P, Delorme M, et al. Perioperative ventilatory strategies in cardiac surgery. Best Prac Res Clin Anaesthesiol, 2015, 29(3): 381-395.
52.	Cappabianca G, Rotunno C, de Luca Tupputi Schinosa L, et al. Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials. J Cardiothorac Vasc Anesth, 2011, 25(1): 156-165.
53.	Dieleman J, Nierich A, Rosseel P, et al. Intraoperative high-dose dexamethasone for cardiac surgery. JAMA, 2012, 308(17): 1761-1767.
54.	Ho K, Tan J. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation, 2009, 119(14): 1853-1866.

1. Jacobs J, He X, Sean M, et al. Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database. Ann Thorac Surg, 2013, 96(3): 757-762.
2. Hassan A, Anderson C, Kypson A, et al. Clinical outcome in patients with prolonged intensive care unit length of stay after cardiac surgical procedures. Ann Thorac Surg, 2012, 93(2): 565-569.
3. Ji Q, Mei Y, Wang X, et al. Risk factors for pulmonary complications following cardiac surgery with cardiopulmonary bypass. Int J Med Sci, 2013, 10(11): 1578-1583.
4. 孙静, 宋静华, 姜楠. 瓣膜置换术后机械通气时间延长的危险因素分析. 山东医药, 2012, 52(20): 36-38.
5. 龚书榕, 张颖蕊, 于荣国. 冠脉旁路移植术后患者延迟撤机的危险因素分析. 中国现代医学杂志, 2012, 22(9): 68-71.
6. 周峻峰, 韩丽丽, 万献尧. 体外循环术后患者延迟撤机的危险因素分析. 医学与哲学(临床决策论坛版), 2008, 12(29): 27-31.
7. Szeles T, Yoshinaga E, Alencar W, et al. Hypoxemia after myocardial revascularization: analysis of risk factors. Rev Bras Anestesiol, 2008, 58(2): 124-136.
8. Reddy S, Grayson A, Griffiths E, et al. Logistic risk model for prolonged ventilation after adult cardiac surgery. Ann Thorac Surg, 2007, 84: 528-536.
9. Rajaei S, Dabbagh A. Risk factors for postoperative respiratory mortality and morbidity in patients undergoing coronary artery bypass grafting. Anesth Pain, 2012, 2(2): 60-65.
10. Anghel D, Anghel R, Corciova F, et al. Preoperative arrhythmias such as atrial fibrillation: cardiovascular surgery risk factor. Biomed Res Int, 2014, 2014: 584918.
11. Stephens R, Whitman G. Postoperative critical care of the adult cardiac surgical patient: Part II: Procedure-specific considerations, management of complications, and quality improvement. Crit Care Med, 2015, 43(9): 1995-2014.
12. Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg, 2016, 49: 5-17.
13. Böning A, Buschbeck S, Roth P, et al. IABP before cardiac surgery: clinical benefit compared to intraoperative implantation. Perfusion, 2013, 28(2): 103-108.
14. Yang F, Wang J, Hou D, et al. Peroperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients. Sci Rep, 2016, 6: 27645.
15. Brown C, Joshi B, Faraday N, et al. Emergency cardiac surgery in patients with acute coronary syndromes: A review of the evidence and perioperative implications of medical and mechanical therapeutics. Anesth Analg, 2011, 112: 777-799.
16. Bartz R, Ferreira R, Schroder J, et al. Prolonged pulmonary support after cardiac surgery: incidence, risk factors and outcomes: a retrospective cohort study. J Crit Care, 2015, 30(5): 940-944.
17. Knapik P, Ciesla D, Borowik D, et al. Prolonged ventilation post cardiac surgery- tips and pitfalls of the prediction game. J Cardiothorac Surg, 2011, 6: 158.
18. Schechter M, Shah A, Englum B, et al. Prolonged postoperative respiratory support after proximal thoracic aortic surgery: Is deep hypothermic circulatory arrest a risk factor? J Crit Care, 2016, 31(1): 125-129.
19. Lamy A, Devereaux P, Yusuf S. Five-year outcomes after off-pump or on-pump coronary-artery bypass grafting. N Engl J Med, 2017, 376(9): 894-895.
20. Santana O, Xydas S, Williams F, et al. Percutaneous coronary intervention followed by minimally invasive valve surgery compared with median sternotomy coronary artery bypass graft and valve surgery in patients with prior cardiac surgery. J Thorac Dis, 2017, 9(Suppl 7): S575-S581.
21. 吴春婷, 赵佳晖, 魏东, 等. 肺功能对合并慢性阻塞性肺疾病患者心脏外科手术预后的影响. 中华结核和呼吸杂志, 2017, 40(02): 86-89.43.
22. Jian L, Sheng S, Min Y, et al. Risk factors for endotracheal re-intubation following coronary artery bypass grafting. J Cardiothorac Surg, 2013, 8: 208.
23. Schechter M, Shah A, Englum B, et al. Prolonged postoperative respiratory support after proximal aortic surgery: Is deep hypothermic circulatory arrest a risk factor? J Crit Care, 2016, 31(1): 125-129.
24. Saleh H, Mohan K, Shaw M, et al. Impact of chronic obstructive pulmonary disease severity on surgical outcomes in patients undergoing non-emergent coronary artery bypass grafting. Eur J Cardiothorac Surg, 2012, 42(1): 108-113.
25. Giakoumidakis K, Eltheni R, Brokalaki H, et al. Preoperative and intraoperative risk factors for prolonged mechanical ventilation among cardiac surgery patients. Health Sci J, 2011, 5(4): 297-305.
26. Hulzebos E, Helders P, Favie N, et al. Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery. JAMA, 2006, 296(15): 1851-1857.
27. Thunberg C, Gaitan B, Grewal A, et al. Pulmonary hypertension in patients undergoing cardiac surgery: Pathophysiology, perioperative management, and outcomes. J Cardiothorac Vasc Anesth, 2013, 27(3): 551-572.
28. Melby S, Moon M, Lindman B, et al. Impact of pulmonary hypertension on outcomes after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg, 2011, 141(6): 1424-1430.
29. Chaudhry M, Omar A, Latif F. Impact of renal dysfunction and peripheral arterial disease on post-operative outcomes after coronary artery bypass grafting. Intech Open. Access Publisher, 2013.
30. Ascione R, Nason G, Al-Ruzzeh S, et al. Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative non-dialysis-dependent renal insufficiency. Ann Thorac Surg, 2001, 72(6): 2020-2025.
31. Hur M, Koo H, Lee C, et al. Preoperative aspirin use and acute kidney injury after cardiac surgery: A propensity-score matched observational study. PloS One, 2017, 12(5): e0177201.
32. WHO Technical Report Series 894. Obesity: Preventing and managing the global epidemic.2000.
33. Ranucci M, Ballotta A, Teresa L, et al. Postoperative hyposia and length of intensive care unit stay after cardiac surgery: the underweight paradox? PLoS One, 2014, 9(4): e93992.
34. Wigfield C, Lindsey J, Muñoz A, et al. Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40. Eur J Cardiothorac Surg, 2006, 29: 434-440.
35. Prabhakar G, Haan C, Peterson E, et al. The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons’ database. Ann Thorac Surg, 2002, 74(4): 1125-1130.
36. Straten A, Bramer S, Soliman M, et al. Effect of body mass index on early and late mortality after coronary artery bypass grafting. Ann Thoeacic Surg, 2010, 89: 30-37.
37. Roman P, Grigore A. Pro: hypothermic cardiopulmonary bypass should be used routinely. J Cardiothorac Vasc Anesth, 2012, 26(5): 945-948.
38. Loor G, Li L, Sabik J, et al. Nadir hematocrit during cardiopulmonary bypass: end-organ dysfunction and mortality. J Thorac Cardiovasc Surg, 2012, 144(3): 654-662.
39. Ranucci M, Conti D, Castelvecchio S, et al. hematocrit on cardiopulmonary bypass and outcome after coronary surgery in nontransfused patients. Ann Thorac Surg, 2010, 89(1): 11-17.
40. Hori D, Nomura Y, Ono M, et al. Optimal blood pressure during cardiopulmonary bypass defined by cerebral autoregulation monitoring. J Thorac Cardiovasc Surg, 2017, 154(5): 1590-1598.
41. Ono M, Brady K, Easley R, et al. Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg, 2014, 147(1): 483-489.
42. Vlaar A, Hofstra J, Determann R, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study. Blood, 2011, 117(16): 4218-4225.
43. McPherson J, Wagner C, Boehm L, et al. Delirium in the cardiovascular ICU: Exploring modifiable risk factors. Crit Care Med, 2013, 41(2): 405-413.
44. Schoen J, Meyerrose J, Paarmann H, et al. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial. Crit Care, 2011, 15(5): R218.
45. Stransky M, Schmidt C, Ganslmeier P, et al. Hypoactive delirium after cardiac surgery as an independent risk factor for prolonged mechanical ventilation. J Cardiothorac Vasc Anesth, 2011, 25(6): 968-974.
46. Shadvar K, Baastani F, Mahmoodpoor A, et al. Evaluation of the prevalence and risk factors of delirium in cardiac surgery ICU. J cardiovasc Thorac Res, 2013, 5(4): 157-161.
47. He S, Chen B, Li W, et al. Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review. J Thorac Cardiovasc Surg, 2014, 148(6): 3148-3155.
48. Lola I, Levidiotou S, Petrou A, et al. Are there independent predisposing factors for postoperative infections following open heart surgery? J Cardiothorac Surg, 2011, 6: 151.
49. Craven D, Hudcova J, Lei Y, et al. Pre-emptive antibiotic therapy to reduce ventilator-associated pneumonia: " thinking outside the box”. Crit Care, 2016, 20(1): 300.
50. Lellouche F, Dionne S, Simard S, et al. High tidal volumes in mechanically ventilation patients increase organ dysfunction after cardiac surgery. Anesthesiology, 2012, 116(5): 1072-1082.
51. Lellouche F, Agrege P, Delorme M, et al. Perioperative ventilatory strategies in cardiac surgery. Best Prac Res Clin Anaesthesiol, 2015, 29(3): 381-395.
52. Cappabianca G, Rotunno C, de Luca Tupputi Schinosa L, et al. Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials. J Cardiothorac Vasc Anesth, 2011, 25(1): 156-165.
53. Dieleman J, Nierich A, Rosseel P, et al. Intraoperative high-dose dexamethasone for cardiac surgery. JAMA, 2012, 308(17): 1761-1767.
54. Ho K, Tan J. Benefits and risks of corticosteroid prophylaxis in adult cardiac surgery: a dose-response meta-analysis. Circulation, 2009, 119(14): 1853-1866.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Progress of risk factor evaluation for prolonged mechanical ventilation after cardiac surgery

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