Causes of Prolonged Mechanical Ventilation After Coronary Artery Bypass Grafting Surgery

Document Type : Original Article

Abstract

Background- Coronary artery bypass grafting surgery (CABG) is a commonly performed
procedure. More than 10,000 CABG surgery procedures are performed in Iran annually.
Prolonged mechanical ventilation following CABG surgery is uncommon. Economic factors
have led to a trend for early tracheal extubation after CABG. Fast-track extubation is variously
defined but most agree that it refers to extubation within 8 hours.
Methods-A descriptive observational study was conducted on 196 patients undergoing CABG
surgery. Following surgery, standard weaning protocol was implemented. Patients who failed
to be extubated within 8 hrs were evaluated.
Results- Four patients (2.04%) died within 3 to 12 days. After undergoing surgery, the minimum
duration of mechanical ventilation was 2 hrs, up to a maximum duration of 19 days. 94.3% of
the patients were extubated within 24 hrs, with a mean duration of 9.54 hrs. 5.7% of the
patients were still intubated after 24h. The most common cause of delayed extubation was
physician trend (n=27, 13.8% of patients). Reduced ejection fraction, EKG changes, elderly
age, prolonged CPB, difficult intubation were reasons for this trend. The second most
common cause was excessive postoperative bleeding, which occurred in 13.3% of the patients.
Four percent of the patients were returned to the operating room for re-exploration.
Cardiovascular instability (11.7%), metabolic acidosis (9.7%), prolonged recovery (4.7%),
neurologic problems (2%), poor FVC (4.6%), hypoxemia (1.5%), and acute respiratory
distress syndrome (ARDS) (0.5%) were other reasons.
Conclusion- The incidence of prolonged mechanical ventilation for more than 24h was similar to
that of the STS database.8 We found the most common cause of delayed extubation to be
physician trend. We recommend changing our strategy in these patients. Excessive
postoperative bleeding incidence in our study was slightly higher than that in other studies.
We found the proportion of patients with failure to extubate due to various reasons would vary
from institution to institution, based on differences in patient population and management
strategies(Iranian Heart Journal 2008; 9 (1):47 -54).

Keywords

References

1. Branca P, McGaw P, Light R. Factors associated
with prolonged mechanical ventilation
following CABG surgery. Chest 2001; 119:
537-546.
2. Cheng DC, Karski J, Peniston C, Raveenndran G,
Sokumar B, Caroll J. Early tracheal extubation
after CABG surgery. Anesthesiology 1996;
85: 1300-1310.
3. Kaplan J, Reich D, Konstadt S. Cardiac
Anesthesia. Philadelphia, W. B. Saunders Co,
1999; 1215-1242.
4. Miller RD. Miller’s Anesthesia. Elsevier-
Churchill-Livingstone, 1999; 1970.
5. Mead MO, Guyatt G, Butler. Trials comparing
early vs. late extubation following
cardiovascular surgery. Chest 2001; 120: 445-
53.
6. Peragallo RA, Cheng DC. Tracheal extubation
should not occur routinely in OR after cardiac
surgery. J Cardiothorac Vasc Anesth 200; 14:
611-13.
7. Reis J, Mota JC, Ponce P, Costa A, Guerreiro M.
Early extubation does not increase
complication rate after CABG surgery with
CPB. Eur J Cardiothorac Surg 2002; 21: 1026-
30.
8. Society of Thoracic Surgeons. National Database.
Available at: http.//www.CTSnet.org.
Accessed June 13, 2002.
9. Nozawa E, Kobayashi E, Matsumoto ME, Feltrim
MIZ, Carmona MJC, Junior JO. Assessment
of factors that influence weaning from longterm
mechanical ventilation after cardiac
surgery. Argent Bras Cardiol 80 (3); Mar
2003.
10. Epstein S, Ciubotaru R, Wong J. Effect of failed
extubation on the outcome of mechanical
ventilation. Chest 1997; 112: 186-92.
11. Bojar R. Manual of Perioperative Care in Adult
Cardiac Surgery. Boston; Blackwell, 2005;
265.
12. Griffin MJ, Hines RL. Management of
perioperative ventricular dysfunction. J.
Cardiothorac Vasc Anesth 2001: 15:90-106.
13. Wan S, Leclerc J, Vincent J. Inflammatory
response to CPB. Chest 1997; 112: 676-692.
14. Gale GD, Teasdle SJ, Sanders DE, et al.
Pulmonary atelectasis and other respiratory
complications after CPB and investigation of
etiological factors. Can Anesth Soc J 1979;
26: 15-27.
15. Mollhoff T, Van Aken H, Muller JP, et al. Effects
of urapidil, ketanserin and Na nitroprusside on
venous admixture and arterial oxygenation
following coronary artery bypass grafting. Br
J Anesth 1990; 64: 493-497.
16. Spivack SD, Shinozaki T, Albertini JJ.
Preoperative prediction of postoperative
respiratory outcome in coronary artery bypass
grafting. Chest 1996; 109: 1222-1230.
17. Neil R, MacIntyre. Evidence-based guidelines for
weaning and discontinuing ventilatory
support. Chest 120; 6: 2001
Iranian Heart Journal
Volume 9, Issue 1
March 2008
Pages 47-54

Files

Share

How to cite

Statistics