Iranian Heart Journal

Iranian Heart Journal

The Influence of the Mechanical Ventilation Weaning Protocol in Patients With Acute Kidney Injury Undergoing Adult Cardiac Surgery

Document Type : Original Article

Authors
Mohsen Ziyaeifard 1
Hojatallah Assadzade 1
Gholamreza Makhmalbaf 2
Ziya Totonchi 1
Zahra Faritous 1
1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.
2 Faculty of medicine, Birjand University of Medical Sciences, IR Iran.
Abstract
Background: Mechanical ventilation is an important risk factor for acute kidney injury (AKI) in cardiac surgery patients. The Weaning protocol can speed weaning after open-heart surgery and might reduce the AKI risk in these patients. We explore the influence of the weaning protocol on the intubation time in cardiac surgery patients who developed AKI.
 
Methods: In a randomized clinical trial, 100 patients with AKI after open-heart surgery were enrolled. After surgery, the patients were randomized to the weaning protocol group (the intervention group) and the conventional weaning group (the control group). Arterial blood gas, hemodynamic variables, the serum blood urea nitrogen level, the creatinine level, and the intubation time were recorded and compared between the 2 groups.
 
Results: The weaning protocol group displayed a statistically significant shorter intubation time than the conventional weaning group (8.89±1.74 h vs 9.93±1.56 h; P=0.002). The postoperative serum urea level (r=0.240, P<0.016) and creatinine level (r=0.245, P<0.014) were positively correlated with the intubation time and the weaning protocol compared with conventional weaning. The weaning protocol decreased the urea and creatinine levels in cardiac surgery patients (P<0.04).
 
Conclusions: The use of the weaning protocol in cardiac surgery patients with AKI conferred shorter intubation times and lower blood urea nitrogen and creatinine levels than the use of conventional weaning. (Iranian Heart Journal 2021; 22(4): 6-14)
Keywords
Randomized controlled trial
Mechanical ventilation
Weaning protocol
Acute kidney injury
  1. Reichert HA, Rath TE. Cardiac surgery in developing countries. The journal of extra-corporeal technology. 2017; 49(2):98.
  2. Braile DM, Godoy MFd. History of heart surgery in the world. Brazilian Journal of Cardiovascular Surgery. 2012;27(1):125-36.
  3. Rodrigues JW, Sams LM. Effectiveness of foot and hand massage on postoperative pain, anxiety and selected physiological parameters among postoperative open heart surgery patients in cardiothoracic intensive care units of selected hospitals of Mangaluru. IJAR. 2018;4(5):461-74.
  4. Brown EN, Burris NS, Gu J, Kon ZN, Laird P, Kallam S, et al. Thinking inside the graft: applications of optical coherence tomography in coronary artery bypass grafting. Journal of biomedical optics. 2007;12(5):051704.
  5. Dağlı M, Yılmaz İS, Çiçek MC, Altınbaş Ö, Baysal AN, Kalender M. Does Ankle Brachial &#x130;ndex Predict Postoperative Acute Renal Failure in Open Heart Surgery Patients? American Journal of Cardiology. 2018;121(8):e27.
  6. Kim JD, Chee HK, Shin JK, Kim JS, Am Lee S, Kim YH, et al. Novel early predictor of acute kidney injury after open heart surgery under cadiopulmonary bypass using plasma neutrophil gelatinase-associated lipocalin. The Korean journal of thoracic and cardiovascular surgery. 2014;47(3):240.
  7. Kim MY, Jang HR, Huh W, Kim Y-G, Kim DJ, Lee YT, et al. Incidence, risk factors, and prediction of acute kidney injury after off-pump coronary artery bypass grafting. Renal failure. 2011;33(3):316-22.
  8. Jo YY, Kim JY, Lee JY, Choi CH, Chang YJ, Kwak HJ. The effect of intraoperative dexmedetomidine on acute kidney injury after pediatric congenital heart surgery: a prospective randomized trial. Medicine. 2017;96(28).
  9. Kwiatkowski DM, Krawczeski CD. Acute kidney injury and fluid overload in infants and children after cardiac surgery. Pediatric Nephrology. 2017;32(9):1509-17.
  10. van den Akker JP, Egal M, Groeneveld AJ. Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis. Critical care. 2013;17(3):R98.
  11. Lombardi R, Nin N, Lorente JA, Frutos-Vivar F, Ferguson ND, Hurtado J, et al. An assessment of the Acute Kidney Injury Network creatinine-based criteria in patients submitted to mechanical ventilation. Clinical journal of the American Society of Nephrology : CJASN. 2011;6(7):1547-55.
  12. Heringlake M, Nowak Y, Schön J, Trautmann J, Berggreen AE, Charitos EI, et al. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients. Critical Care. 2014;18(5):547.
  13. Mohsen Ziyaeifard, Azin Alizadehasl,1 Nahid Aghdaii, Poupak Rahimzadeh,2 Gholamreza Masoumi,3 Samad EJ Golzari,4 Mostafa Fatahi,5 and Farhad Gorjipur The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery. J Res Med Sci. 2016; 21: 113. Published online 2016 Nov 7. doi: 10.4103/1735-1995.193504
  14. Aghdaii, N., Ziyaeifard, M.,  Faritus, S.Z.,  Azarfarin, R.Hemodynamic responses to two different anesthesia regimens in compromised left ventricular function patients undergoing coronary artery bypass graft surgery: Etomidate-midazolam versus propofol-ketamine. Anesthesiology and Pain MedicineVolume 5, Issue 3, 22 June 2015, Article number e27966, 6p
  15. Noizet O, Leclerc F, Sadik A, Grandbastien B, Riou Y, Dorkenoo A, et al. Does taking endurance into account improve the prediction of weaning outcome in mechanically ventilated children? Critical Care. 2005;9(6):R798.
  16. Khalafi A, Elahi N, Ahmadi F. Continuous care and patients’ basic needs during weaning from mechanical ventilation: A qualitative study. Intensive and Critical Care Nursing. 2016;37:37-45.
  17. Blackwood B, Alderdice F, Burns K, Cardwell C, Lavery G, O’Halloran P. Use of weaning protocols for reducing duration of mechanical ventilation in critically ill adult patients: Cochrane systematic review and meta-analysis. Bmj. 2011;342:c7237.
  18. Marelich GP, Murin S, Battistella F, Inciardi J, Vierra T, Roby M. Protocol Weaning of Mechanical Ventilation in Medical and Surgical Patients by RespiratoryCare Practitioners and Nurses: Effect on Weaning Time and Incidence of Ventilator-Associated Pneumonia. Chest. 2000;118(2):459-67.
  19. Nemer SN, Barbas CS. Predictive parameters for weaning from mechanical ventilation. Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia. 2011;37(5):669-79.
  20. Abu-Omar Y, Ratnatunga C. Cardiopulmonary bypass and renal injury. Perfusion. 2006;21(4):209-13.
  21. Faritous, Z.,Barzanji, A.,Azarfarin, R.,Ghadrdoost, B.,Ziyaeifard, M.,Aghdaei, N., Alavi, M.Comparison of bispectral index monitoring with the critical-care pain observation tool in the pain assessment of intubated adult patients after cardiac surgery(Article) Anesthesiology and Pain MedicineVolume 6, Issue 4, August 2016, Article number e38334, 5p
  22. Mao H, Katz N, Ariyanon W, Blanca-Martos L, Adýbelli Z, Giuliani A, et al. Cardiac surgery-associated acute kidney injury. Cardiorenal medicine. 2013;3(3):178-99.
  23. Brito DJdA, Nina VJdS, Nina RVdAH, Oliveira MIGd, Salgado JVL, Lages JS, et al. Prevalence and risk factors for acute renal failure in the postoperative of coronary artery bypass grafting. Brazilian Journal of Cardiovascular Surgery. 2009;24(3):297-304.
  24. Lellouche F, Mancebo J, Jolliet P, Roeseler J, Schortgen F, Dojat M, et al. A multicenter randomized trial of computer-driven protocolized weaning from mechanical ventilation. American journal of respiratory and critical care medicine. 2006;174(8):894-900.
  25. Ziyaeifard, M.a,  Alizadehasl, A.a,  Aghdaii, N.a,  Sadeghi, A.aEmail Author,  Azarfarin, R.a,  Masoumi, G.b,  Golbargian, G.a Heparinized and saline solutions in the maintenance of arterial and central venous catheters after cardiac surgery.Anesthesiology and Pain MedicineVolume 5, Issue 4, 1 August 2015, Article number e23963, 5p
  26. Chaiwat O, Sarima N, Niyompanitpattana K, Komoltri C, Udomphorn Y, Kongsayreepong S. Protocol-directed vs. physician-directed weaning from ventilator in intra-abdominal surgical patients. J Med Assoc Thai. 2010;93(8):930-6.
  27. Fan L, Su Y, Elmadhoun OA, Zhang Y, Zhang Y, Gao D, et al. Protocol-directed weaning from mechanical ventilation in neurological patients: a randomised controlled trial and subgroup analyses based on consciousness. Neurological research. 2015;37(11):1006-14.
  28. Zhu F, Gomersall CD, Ng SK, Underwood MJ, Lee A. A randomized controlled trial of adaptive support ventilation mode to wean patients after fast-track cardiac valvular surgery. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2015; 122(4):832-40.
Iranian Heart Journal
Volume 22, Issue 4
Autumn 2021
Pages 6-14