الفهرس 
Cardiac SurgeryOnly 14 pages are availabe for public view
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Abstract
After cardiac surgery patients are admitted to a cardio surgical intensive care unit for high-intensity multi-professional/multidisciplinary care, based in particular on mechanical ventilation, hemodynamic support and uninterrupted instrumental and clinical monitoring. In these patients, the occurrence of postoperative complications, such as prolonged ventilation and reintubation, should be monitored as morbidity measures to assess the quality of care. The time to tracheal extubation and the length of stay (LOS) in the CICU are considered to be endpoints in studies on cardiac surgery patients.
Nevertheless, weaning from mechanical ventilation and extubation can be difficult in certain patients, for whom delayed or premature extubations can lead to the need for reintubation or unplanned non-invasive mechanical ventilation (NIMV). Extubation failure can occur soon or several days after extubation and is associated with significantly prolonged mechanical ventilation, prolonged hospital LOS and increased mortality.
Studies have shown that, after cardiac surgery, Extubation failure can be predicted by several variables related to past medical history, (e.g. chronic diseases and severe left ventricular dysfunction), laboratory data (e.g. haematocrit, serum albumin and urea), respiratory variables (e.g. rapid shallow breathing index (RSBI)), haemodynamic variables (e.g. the insertion of an intra-aortic balloon pump, ejection fraction and systemic oxygen delivery) and surgery (e.g. the complexity and length of surgery and extracorporeal circulation time). However, other potential predictors have not been adequately considered.
from the findings of this study we can conclude that SOFA score (≥ 6), charlson comorbidity index (>3), RR/TV (≥57), Minute volume (≥ 13.5) are independent predictors of failed weaning from mechanical ventilation in post cardiac surgery patients.
The main results of the study revealed that:
The current study included 80 patients, their age ranged between 30- 73 years with mean value of 55.475 (± 8.732) years. Most of them were males 76.3% and 23.8% were females. 30% of them were smokers. Their BMI mean value was 25.807 (± 6.618).
Charlson comorbidity index ranged between 1 - 6. Most of included patients have index ≤ 3; 37.5% has index 1, 28.8% has index 2 and 25% has index 3. The commonest comorbidities were IHD in 57.5% followed by HTN in 37.5% then DM in 36.25% and cardiac valve lesions in 21.25%.
Most of the included patients (91.3%) were successfully extubated in the first 48h while 8.8% failed extubation, 4 re-ventilated on noninvasive CPAP, 3 needed re- ventilation with invasive MV. One have done tracheostomy and one failed to survive and died.
Most of the included patients 67.5% developed intraoperative complications; the commonest complications were pacemaker wire insertion in 36.25% followed by VF in 27.5% and bradycardia 5% of included patients.
Most of the included patients have CABG (63.8%) followed by MVR in 16.3%. Echocardiography demonstrated that preoperative left ventricle EF% ranged between 32 -72%.
ECC time of the studied population ranged between 50 – 300 min with a mean value of 122.925 (± 44.891) and ACC time ranged between 30 – 200 min with a mean value of 78.225 (± 28.236).
MAP of the studied population ranged between 56 – 103 mmHg with mean value of 85.037 (± 9.914) mmHg. Among the studied population, 90% received one or more blood product transfusion; 80.1% received packed RBCs, 57.5% received FFP and 7.5% received platelet transfusion.
Among the studied population, the SOFA score ranged from 3 to 13 with median of 8.
The median of RR/TV of included patients was 41.5 with range 10- 120 and the median of Pao2/FIo2 was 253.5 with range 120-421. The mean minute Volume was 11.537 (± 2.585) L/min and the mean max inspiratory pressure was -27.037(± 3.144) cmH20.
Mean age of successful weaned patients was 55.277 ± 9.014 ,mean BMI was 25.687± 5.5, 54.7% were smokers , 75.3% were males , median charlson comorbidity index was 2 with IHD was the commonest comorbidity , mean preoperative LV EF was 57.479 (± 6.642) and the mortality rate in this group was zero.
The commonest type of surgery done in the successful weaned group was CABG (61.6%) followed by MVR , the complication rate was 68.5% , mean ECC time was 119.986 (± 44.129) min and Mean ACC time was 77.055 (± 28.331) min. 90.4% of successful weaned patients received blood transfusion with 79.5% received PRBCS , 58.9% received FFP and 6.8% received platelets transfusion.
Among the successful weaned group the SOFA score ranged from 3-8 with median of 5, mean MAP was 86.616 (± 8.068)mmHg, mean Pao2/FIo2 was 267 (± 48.875), mean Minute Volume was 11.164(± 2.273) , mean Max inspiratory pressure was -27.699 (± 2.277).
While mean age of failed weaning patients was 58.285 (± 5.282) ,mean BMI was 27.18(± 5.272), 85.7% were smokers , 71.4% were males , median charlson comorbidity index was 3 with IHD was the commonest comorbidity followed by COPD (57.1%) , mean preoperative LV EF was 51.429 (± 12.934) and the mortality rate in this group was14.2%
The commonest type of surgery done in the failed weaning group was CABG (85.7%)followed by MVR , the complication rate was 85.7%, mean ECC time was 153. 571 (± 44.320) min and Mean ACC time was 130.429 (± 25.993) min. All failed weaning patients received blood transfusion with 85.7% received PRBCS, 42.9% received FFP and 14.2% received platelets transfusion.
Among the failed weaning group the SOFA score ranged from 5-13 with range of 9, mean MAP was 68.571 (± 12.895), mean RR/TV was 99.143 (± 31.667), mean Pao2/FIo2 was 183.429 (± 43.003), mean Minute Volume was 15.429 (± 2.573) , mean Max inspiratory pressure was -20.143 (± 2.673)..
At cutoff value ≥ 57 RR/TV has 85.7% sensitivity and 89% specificity, at cutoff value ≥ 13.5 MV has 85.7% sensitivity and 84.9% specificity, at cutoff value ≥ -23 MIP has 85.7% sensitivity and 98.6% specificity, at cutoff value ≥ 6 SOFA score has 85.7% sensitivity and 72.6% specificity to predict failed weaning from mechanical ventilation in post cardiac surgery patients.
At cutoff value ≥ 218 PaO2/FIO2 has 89% sensitivity and 71.4% specificity, at cutoff value ≥ 72 MAP has 98.6% sensitivity and 71.4% specificity to predict successful weaning from mechanical ventilation in post cardiac surgery patients.
Binary logistic regression analysis showed that SOFA score (≥ 6), charlson comorbidity index (>3), RR/TV (≥57), Minute volume (≥ 13.5) are independent predictors of failed weaning from mechanical ventilation in post cardiac surgery patients.