Current Meeting Home Final Program Past & Future Meetings

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 CausePMV/RI
(n=173)
PMV
(n=93)
RI
(n=80)
Cardiac40%53%26%
Respiratory32%26%39%
Neurological8%9%7%
Bleeding11%5%18%
Infection4%2%6%
Systems2%3%0%
Misc3%2%4%

Table 1


Back to 2015 Annual Meeting Posters


© 2021 New England Surgical Society. All Rights Reserved. Privacy Policy.