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Ventilatory dependency after cardiovascular surgery

Published byΣεμέλη Κανακάρης-Ρούφος Modified over 5 years ago

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Presentation on theme: "Ventilatory dependency after cardiovascular surgery"— Presentation transcript:

1 Ventilatory dependency after cardiovascular surgery
Sudish C. Murthy, MD, PhD, Alejandro C. Arroliga, MD, Peter A. Walts, MD, Jingyuan Feng, MS, Jean-Pierre Yared, MD, Bruce W. Lytle, MD, Eugene H. Blackstone, MD  The Journal of Thoracic and Cardiovascular Surgery  Volume 134, Issue 2, Pages e6 (August 2007) DOI: /j.jtcvs Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Relationship of various factors to postoperative ventilatory dependency. Closed circles represent summary data, and solid lines are trend lines enclosed within 68% confidence limits (±1 standard error). A, Heart rate at anesthesia induction. B, Pulmonary artery (PA) diastolic pressure at intensive care unit (ICU) admission. C, Cardiac index at ICU admission. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Survival of patients experiencing ventilatory dependency. Symbols represent deaths, vertical lines are 68% CLsequivalent to ±1 standard error, and numbers in parentheses are patients remaining at risk. Solid lines enclosed within dashed CLs are parametric estimates. Time zero is after 72 cumulative hours of intubation after cardiovascular surgery. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Timing of tracheostomy after onset of ventilatory dependency.
The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

5 Figure 4 Observed (open circles) versus predicted (solid line enclosed within dashed 68% CLs) survival after tracheostomy. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

6 Figure E1 Relationship of various factors to postoperative ventilatory dependency. Closed circles represent summary data, and solid lines are trend lines enclosed within 68% confidence limits (±1 standard error). A, Date of operation. B, Preoperative hematocrit. C, Cardiopulmonary bypass (CPB) time. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

7 Figure E2 Univariable trends of risk factors with 2-year survival. A, Cardiac index at intensive care unit (ICU) admission. B, Acidosis at ICU admission. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

8 Figure E3 Relationship of age and timing of tracheostomy.
The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

9 Figure E4 Instantaneous risk of events. A, Competing risks of death before tracheostomy and of undergoing tracheostomy among patients with ventilatory dependency. Time zero is 72 cumulative hours of intubation after cardiovascular surgery. B, Result of simultaneous risk of competing events on prevalence of each state. All patients start in the state “event-free survival” and migrate at rates shown in panel A into “death before tracheostomy” or “tracheostomy.” The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

10 Figure E5 Predicted survival after developing ventilatory dependency, in the competing-risks format of Figure E4, B. A, Low-risk patient (see table). B, High-risk patient (see table).Low riskHigh risk50Age (y)7080Pao2 (mm Hg)8015Ppa, diastolic (mm Hg)2090Aortic clamp time (min)90110Total CPB time (min)20072Interval from end of operation to ventilatory dependency (h)20024HCO3− (mmol·L−1)237,200Minute volume (L·min−1)5,0003Cardiac index (L·min−1·m−2)2.216BUN (mg·dL−1)37NoInsulin-treated diabetesYesNoVasopressinYesNoHypertensionYesNoCOPDYesValues for variables used to simulate low- and high-risk patients. These values are used in multivariable equations, represented by Tables 2 and 3, for all-cause mortality after development of ventilatory dependency and for time to tracheostomy. BUN, blood urea nitrogen; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass. The Journal of Thoracic and Cardiovascular Surgery  , e6DOI: ( /j.jtcvs ) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

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