Predictors of postoperative prolonged mechanical ventilation after left ventricular assist device surgery

Aim: Prolonged mechanical ventilation (PMV) after cardiovascular surgeries is associated with morbidity and mortality. The aim ofthe study was to determine the risk factors for postoperative PMV (PPMV) after left ventricular assist device (LVAD) surgery.Material and Methods: We retrospectively analyzed the data of patients who underwent LVAD surgery between 2011 and 2016.Prolonged mechanical ventilation was defined as postoperative tracheal extubation 24 hours after the patient is admitted to the ICU.Patients were divided into two groups whether they were extubated within 24 hours of surgery or extubated after 24 hours followingsurgery.Results: During the study period, a total of fifty-seven patients were admitted to ICU. Fifty-seven patients’ data were screened. Themean age of the 57 patients enrolled was 44.6 ± 16.1 years. Of them, 82% were male, and 54 (95%) patients had dilated cardiomyopathydiagnosis. A total of 26 (46%) patients required PPMV. The two groups were similar in terms of demographics, duration of surgery,postoperative LVAD flow rates, presence of preoperative MV, infections, and circulatory support devices (p > 0.05). Patients whorequired PPMV underwent more revision surgeries [14 (54%) vs. 2 (7%), p < 0.001] and had higher incidences of acute kidney injury(AKI) on the first day after the surgery [13 (50%) vs. 4 (13%), p = 0.003] compared with those who did not require PPMV. Furthermore,the patients who required PPMV also required more renal replacement therapies postoperatively [12 (46%) vs. 5 (16%), p = 0.02] andhad longer intensive care unit stay (30.1±25.2 days vs. 14.0 ±11.4 days, p = 0.002) and had higher hospital mortality (58% vs. 35%, p= 0.043) and 30-day mortality (38% vs. 16%, p = 0.042) than those who did not require PPMV. Logistic regression analysis revealedpostoperative AKI as an independent risk factor for PPMV (OR = 0.223, 95% CI 0.067–0.743, p = 0.015).Conclusion: Our results revealed that almost half of the patients who underwent LVAD surgery required PPMV. AKI on the first dayfollowing surgery is an independent risk factor for PPMV.

PDF

___

1. Degertekin M, Erol Ç, Ergene O, et al. Heart failure prevalence and predictors in Turkey: HAPPY study. Turk Kardiyol Dern Ars 2012;40:298-308.
2. Lietz K, Long J, Kfoury A. Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era. Implications For Patient Selection 2007;116.
3. Totonchi Z, Baazm F, Chitsazan M, et al. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res 2014;6:211.
4. Trouillet J-L, Combes A, Vaissier E, et al. Prolonged mechanical ventilation after cardiac surgery: outcome and predictors. J Thorac Cardiovasc Surg 2009;138:948-53.
5. Prodhan P, Kalikivenkata G, Tang X, et al. Risk factors for prolonged mechanical ventilation for children on ventricular assist device support. Ann Thorac Surg 2015;99:1713-8.
6. Group KDIGOAKIW. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.
7. Papathanasiou M, Mincu RI, Lortz J, et al. Prolonged mechanical ventilation after left ventricular assist device implantation: risk factors and clinical implications. ESC Heart Failure 2019;6:545-51.
8. Fernandez-Zamora MD, Gordillo-Brenes A, BanderasBravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery. Respiratory Care 2018;63:550-7.
9. Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2017;153:108-15.
10. Chaiwat O, Chittawatanarat K, Piriyapathsom A, et al. Incidence and Outcomes of Prolonged Acute Mechanical Ventilation of Surgical Patients in Academic Hospitals. J Med Assoc Thai 2017;100:20.
11. Wong WT, Lai VK, Chee YE, et al. Fast-track cardiac care for adult cardiac surgical patients. Cochrane Database Syst Rev 2016.
12. Lima CA, Ritchrmoc MK, Leite WS, et al. Impact of fast-track management on adult cardiac surgery: clinical and hospital outcomes. Rev Bras Ter Intensiva 2019;31.
13. O’Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Critical cCare 2016;20:187.
14. Siddiqui M-MA, Paras I, Jalal A. Risk factors of prolonged mechanical ventilation following open heart surgery: what has changed over the last decade? Cardiovasc Diagn Ther 2012;2:192.
15. 15. Filsoufi F, Rahmanian PB, Castillo JG, et al. Predictors and early and late outcomes of respiratory failure in contemporary cardiac surgery. Chest 2008;133:713-721.
16. Wu Y-K, Kao K-C, Hsu K-H, et al. Predictors of successful weaning from prolonged mechanical ventilation in Taiwan. Respiratory Med 2009;103:1189-1195.
17. Zhao Z-Y, Wu N, Deng S-X, et al. Serum albumin is a predictor for duration of weaning in patients with traumatic brain injury. Int J Clin Exp Med 2016;9:4041-6.
18. Allou N, Bronchard R, Guglielminotti J, et al. Risk factors for postoperative pneumonia after cardiac surgery and development of a preoperative risk score. Critical Care Med 2014;42:1150-16.
19. Hortal J, Giannella M, Pérez MJ, et al. Incidence and risk factors for ventilator-associated pneumonia after major heart surgery. Intensive Care Med 2009;35:1518-25.
20. LaPar DJ, Gillen JR, Crosby IK, et al. Predictors of operative mortality in cardiac surgical patients with prolonged intensive care unit duration. JJ Am Coll Surg 2013;216:1116-23.
21. Rajakaruna C, Rogers C, Angelini G, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg 2005;130:1270-7.