Predictors of prolonged mechanical ventilation after coronary artery bypass grafting among Filipino adults with coronary artery disease

  • Joseph Jasper S Acosta Southern Philippines Medical Center
  • Jessie F Orcasitas Southern Philippines Medical Center, Brokenshire Memorial Hospital, Metro Davao Medical and Research Center, Davao Doctors Hospital, San Pedro Hospital of Davao City Inc., Davao Adventist Hospital, Ricardo Limso Medical Center, Malta Medical Center, Community Health & Development Cooperative Hospital

Abstract

Background. Identifying risk factors for prolonged mechanical ventilation (PMV) can improve postoperative outcomes of patients undergoing coronary artery bypass grafting (CABG).
Objective. To determine the occurrence rate and predictors of PMV among patients who underwent CABG.
Design. Retrospective cohort study.
Setting. Southern Philippines Medical Center Heart Institute, Davao City, Philippines.
Participants. 213 patients with coronary artery disease (CAD) who underwent CABG.
Main outcome measures. There were 167 (78.4%) males and 46 (21.6%) females in this study. The patients had a mean age of 60.2 ± 9.68 years and a mean BMI of 25.8 ± 5.65 kg/m2. Post-CABG, PMV occurred in 18.87% of the patients. Univariate odds ratios of PMV were significantly high for renal dysfunction (OR=2.75; 95% CI 1.34-5.66), New York Heart Association functional class IV (7.53; 3.07-18.46), angina grade IV (4.52; 1.69-12.07), left ventricular ejection fraction <50% (2.80; 1.23-6.38), cardiogenic shock (12.14; 2.26-65.11), intraoperative IABP insertion (3.17; 1.46-6.88), postoperative acute kidney injury (AKI) (6.72; 2.99-15.10), postoperative hemodialysis (4.84; 2.21-10.60), postoperative neurological complications (13.04; 4.21-40.39), postoperative arrhythmia (2.59; 1.19-5.63), pulmonary complications (3.50;1.67-7.34), and other complications (3.44;1.22-9.68). On multiple regression analysis, AKI after CABG significantly increased the odds ratio of PMV (11.82;1.03-135.35).
Conclusion. PMV after CABG occurred in 18.87% of the patients in our study and was associated with poor preoperative cardiac and renal conditions, intraoperative IABP insertion, and postoperative complications. The development of AKI after CABG independently increased the odds ratio of PMV.

Published
Dec 29, 2016
Issue
Vol 2 No 1 (2016)
Section
Research

Keywords

early extubation, acute kidney injury, EuroSCORE II, Society of Thoracic Surgeons Adult Cardiac Surgery Risk
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