Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial;

Fecha de publicación: 01/01/2022

Autores de IIS La Fe

Paula Carmona García

Autor

Participantes ajenos a IIS La Fe

Sankar A.
Rotstein A.J.
Teja B.
Carrier F.M.
Belley-Côté E.P.
Bolliger D.
Saha T.
Sander M.
Shehata N.
Thorpe K.E.
Mazer C.D.

Grupos

Medicina Perioperatoria, Anestesiología y Reanimación

Abstract

Purpose: Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications. Methods: Four thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored. Results: Prolonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications. Conclusion: In this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors. Study registration: www.ClinicalTrials.gov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial. © 2022, Canadian Anesthesiologists' Society.

Datos de la publicación

ISSN/ISSNe:: 0832-610X, 1496-8975
Tipo:: Article
Páginas:: 1493-1506
DOI:: 10.1007/s12630-022-02319-9
PubMed:: 36123418
Enlace a otro recurso:: www.scopus.com
Factor de Impacto:: 1,053 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Métricas

Filiaciones

Sankar A.:: Department of Anesthesia, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St., Toronto, M5B 1W8, ON, Canada

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
Rotstein A.J.:: Department of Anesthesia, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St., Toronto, M5B 1W8, ON, Canada

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
Teja B.:: Department of Anesthesia, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St., Toronto, M5B 1W8, ON, Canada

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
Belley-Côté E.P.:: Department of Medicine, McMaster University, Population Health Research Institute, David Braley Cardiac, Vascular, and Stroke Research Institute, Hamilton, ON, Canada
Bolliger D.:: Clinic for Anaesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland
Saha T.:: Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, ON, Canada
Carmona P.:: Department of Anesthesiology and Perioperative Medicine, University Hospital La Fe, Valencia, Spain
Sander M.:: Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, UKGM, Justus-Liebig University Giessen, Giessen, Germany
Shehata N.:: Departments of Medicine, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

Division of Hematology, Mount Sinai Hospital, Toronto, ON, Canada

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
Thorpe K.E.:: Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada

Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

Applied Health Research Centre (AHRC), Toronto, ON, Canada
Mazer C.D.:: Department of Anesthesia, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St., Toronto, M5B 1W8, ON, Canada

Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada

Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada

Department of Physiology, University of Toronto, Toronto, ON, Canada

Keywords

Blood Transfusion; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Humans; Postoperative Complications; Respiration, Artificial; Risk Factors; aged; Article; artificial ventilation; cardiopulmonary bypass; clinical outcome; controlled study; correlation analysis; female; heart left ventricle failure; heart surgery; human; intensive care; kidney failure; long term care; major clinical study; male; multinomial logistic regression; multivariate logistic regression analysis; odds ratio; operation duration; patient history of surgery; patient selection; perioperative period; postoperative complication; preoperative period; pulmonary hypertension; pulmonology; randomized controlled trial (topic); secondary analysis; Society of Thoracic Surgeons score; surgical mortality; surgical risk; thorax surgery; adverse event; blood transfusion; postoperative complication; risk factor

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