Retrospective analysis of pre- and intraoperative risk factors for readmission to the intensive care unit after fast track cardiac surgery

Background Risk factors of delayed extubation, prolonged intensive care unit (ICU) length of stay (LOS), and mortality have not been studied for patients administered fast-track cardiac anesthesia (FTCA). The authors' goals were to determine risk factors of outcomes and cardiac risk scores (CRS) for CABG patients undergoing FTCA. Methods Consecutive CABG patients undergoing FTCA were prospectively studied. Outcome variables were delayed extubation > 10 h, prolonged ICU LOS > 48 h, and mortality. Univariate analyses were performed followed by multiple logistic regression to derive risk factors of the three outcomes. Simplified integer-based CRS were derived from logistic models. Bootstrap validation was performed to assess and compare the predictive abilities of CRS and logistic models for the three outcomes. Results The authors studied 885 patients. Twenty-five percent had delayed extubation, 17% had prolonged ICU LOS, and 2.6% died. Risk factors of delayed extubation were increased age, female gender, postoperative use of intraaortic balloon pump, inotropes, bleeding, and atrial arrhythmia. Risk factors of prolonged ICU LOS were those of delayed extubation plus preoperative myocardial infarction and postoperative renal insufficiency. Risk factors of mortality were female gender, emergency surgery, and poor left ventricular function. CRSs were modeled for the three outcomes. The area under the receiver operating characteristic curve for the CRS-logistic models was not significantly different: 0.707/0.702 for delayed extubation, 0.851/0.855 for prolonged ICU LOS, and 0.657/0.699 for mortality. Conclusion In CABG patients undergoing FTCA, the authors derived and validated risk factors of delayed extubation, prolonged ICU LOS, and mortality. Furthermore, they developed a simplified CRS system with similar predictive abilities as the logistic models.

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Risk Factors and Outcomes Associated With Readmission to the Intensive Care Unit After Cardiac Surgery

AACN Advanced Critical Care ◽

10.4037/aacnacc2016451 ◽

2016 ◽

Vol 27 (1) ◽

pp. 29-39 ◽

Cited By ~ 3

Author(s):

Young Ae Kang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Mechanical Ventilation ◽

Cardiac Surgery ◽

Intensive Care ◽

Hospital Stay ◽

Operation Time ◽

Unplanned Readmission ◽

High Blood Glucose ◽

Icu Discharge

Unplanned readmission to the intensive care unit (ICU) is associated with poor prognosis, longer hospital stay, increased costs, and higher mortality rate. In this retrospective study, involving 1368 patients, the risk factors for and outcomes of ICU readmission after cardiac surgery were analyzed. The readmission rate was 5.9%, and the most common reason for readmission was cardiac issues. Preoperative risk factors were comorbid conditions, mechanical ventilation, and admission route. Perioperative risk factors were nonelective surgery, duration of cardiopulmonary bypass, and longer operation time. Postoperative risk factors were prolonged mechanical ventilation time, new-onset arrhythmia, unplanned reoperation, massive blood transfusion, prolonged inotropic infusions, and complications. Other factors were high blood glucose level, hemoglobin level, and score on the Acute Physiology and Chronic Health Evaluation II. In-hospital stay was longer and late mortality was higher in the readmitted group. These data could help clinical practitioners create improved ICU discharge protocols or treatment algorithms to reduce length of stay or to reduce readmissions.

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Intraoperative Pathophysiological Changes and Therapeutic Interventions in Patients Undergoing On-pump Cardiac Surgery May be Risk Factors for the Development of Post-operative Delirium in the Cardiac Intensive Care Unit: A Prospective Observational Study

10.46889/jsrp.2021.2301 ◽

2021 ◽

Vol 02 (03) ◽

Author(s):

Abdallah Halahla ◽

Aidah Alkaissi ◽

Wael Sadaqa

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Cardiac Surgery ◽

Intensive Care ◽

Observational Study ◽

Prospective Observational Study ◽

Therapeutic Interventions ◽

Cardiac Intensive Care Unit ◽

Cardiac Intensive Care

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High Tidal Volumes in Mechanically Ventilated Patients Increase Organ Dysfunction after Cardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182522df5 ◽

2012 ◽

Vol 116 (5) ◽

pp. 1072-1082 ◽

Cited By ~ 147

Author(s):

François Lellouche ◽

Stéphanie Dionne ◽

Serge Simard ◽

Jean Bussières ◽

François Dagenais

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Body Weight ◽

Cardiac Surgery ◽

Intensive Care ◽

Lung Injury ◽

Tidal Volume ◽

Organ Failure ◽

Predicted Body Weight ◽

Prolonged Stay

Background High tidal volumes in patients with acute respiratory distress syndrome and acute lung injury lead to ventilator-induced lung injury and increased mortality. We evaluated the impact of tidal volumes on cardiac surgery outcomes. Methods We examined prospectively recorded data from 3,434 consecutive adult patients who underwent cardiac surgery. Three groups of patients were defined based on the tidal volume delivered on arrival at the intensive care unit: (1) low: below 10, (2) traditional: 10-12, and (3) high: more than 12 ml/kg of predicted body weight. We assessed risk factors for three types of organ failure (prolonged mechanical ventilation, hemodynamic instability, and renal failure) and a prolonged stay in the intensive care unit. Results The mean tidal volume/actual weight was 9.2 ml/kg, and the tidal volume/predicted body weight was 11.5 ml/kg. Low, traditional, and high tidal volumes were used in 724 (21.1%), 1567 (45.6%), and 1,143 patients (33.3%), respectively. Independent risks factors for high tidal volumes were body mass index of 30 or more (odds ratio [OR] 6.25; CI: 5.26-7.42; P < 0.001) and female sex (OR 4.33; CI: 3.64-5.15; P < 0.001). In the multivariate analysis, high and traditional tidal volumes were independent risk factors for organ failure, multiple organ failure, and prolonged stay in the intensive care unit. Organ failures were associated with increased intensive care unit stay, hospital mortality, and long-term mortality. Conclusion Tidal volumes of more than 10 ml/kg are risk factors for organ failure and prolonged intensive care unit stay after cardiac surgery. Women and obese patients are particularly at risk of being ventilated with injurious tidal volumes.

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