Back to 2015 Annual Meeting Posters

---

Causes of Prolonged Mechanical Ventilation and Re-Intubation after Non-Emergent Coronary Artery Bypass Grafting
*John M Fallon¹, *Zachary Kanouse², *David J. Malenka¹, *Mohammad Jafferji¹, *Stephen Surgenor¹, *Jeff Brown³, *Bruce Leavitt², *Margaret T. Russell¹, *Cathy Ross¹, *Beatriz Jauregui⁴, *Kelly LeBlond⁵, *Anne Knight⁶, *Elaine Olmstead¹, *Anthony DiScipio¹, for the Northern New England Cardiovascular Disease Study Group
¹Dartmouth-Hitchcock Medical Center, Lebanon, NH;²University of Vermont Medical Center, Burlington, VT;³Maine Medical Center, Portland, ME;⁴Catholic Medical Center, Manchester, NH;⁵Central Maine Medical Center, Lewiston, ME;⁶Concord Hospital, Concord, NH

Objective
Risk factors for prolonged mechanical ventilation (PMV) and re-intubation (RI) after coronary artery bypass grafting (CABG) have been identified. The goal of this study was to identify more proximate causes of PMV/RI from which patients might be rescued.
Design
Observational study and regional chart review.
Setting
Northern New England Cardiovascular Disease Study Group.
Patients
Our regional registry was queried from 2010-2013 for isolated, non-emergent CABG surgery (n=5,215). We identified patients with PMV (intubated ≥48 hours postop) or RI (n=225).
Intervention(s)
N/A
Main Outcome
In-hospital mortality.
Results
Prevalence of PMV/RI was 4.3% (PMV n=117, RI n=108). Observed in-hospital mortality of PMV (11%) and RI (33%) was significantly higher than predicted mortality (1.5% and 1.6%) and mortality of a propensity matched cohort without PMV/RI (0.4% p-value <0.001). Among chart-reviewed patients the frequency of PMV and RI was similar (PMV 54%, RI 46%). The majority of PMV/RI was attributed to either cardiac (40%) or respiratory (32%) causes (Table 1). Of those with cardiac or respiratory causes of PMV/RI (n=125), major contributing factors (not mutually exclusive) were hypoxemic respiratory failure (48%), low output failure (47%), and arrhythmia (26%). Of patients who died (n=38), cardiac causes accounted for the majority (61%) of deaths.
Conclusions
Patients who develop PMV or RI have high mortality. Of many pathologies that could lead to cardiac and respiratory causes of PMV/RI, the most frequent contributing factors in this study were hypoxic respiratory failure, low output failure, and arrhythmia. Improvement efforts should focus on preventing these acquired conditions.

Primary Cause	PMV/RI (n=173)	PMV (n=93)	RI (n=80)
Cardiac	40%	53%	26%
Respiratory	32%	26%	39%
Neurological	8%	9%	7%
Bleeding	11%	5%	18%
Infection	4%	2%	6%
Systems	2%	3%	0%
Misc	3%	2%	4%

Table 1

---

Back to 2015 Annual Meeting Posters