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ObjectivesThe 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.DesignA 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.SettingTertiary cardiothoracic ICU.ParticipantsA total of 2,098 patients were included and analyzed.InterventionsNone.Measurements and main resultsThe 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.ConclusionsEscalation 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.

Original publication

DOI

10.1053/j.jvca.2019.10.052

Type

Journal article

Journal

Journal of cardiothoracic and vascular anesthesia

Publication Date

05/2020

Volume

34

Pages

1226 - 1234

Addresses

University Hospitals Birmingham National Health Service Foundation Trust, Department of Anesthesia and Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK; University Hospitals of Leicester National Health Service Trust, Department of Anesthesia and Intensive Care Medicine, Glenfield Hospital, Leicester, UK. Electronic address: vasileioszochios@doctors.org.uk.

Keywords

Humans, Respiration, Artificial, Length of Stay, Cardiac Surgical Procedures, Retrospective Studies, Cohort Studies, Noninvasive Ventilation