Respiration, artificial

IJCS

Original Article

Risk Score for Prolonged Mechanical Ventilation in Coronary Artery Bypass Grafting

Fernanda Dallazen-Sartori et al. Luciano Cabral Albuquerque João Carlos Vieira da Costa Guaragna Ellen Hettwer Magedanz … João Batista Petracco Rodrigo Bodanese Mario Bernardes Wagner Luiz Carlos Bodanese

Abstract

Background

Prolonged mechanical ventilation (MV) after cardiac surgery imposes a significant burden on the patient in terms of morbidity and financial hospital costs.

Objective

To develop a risk score model to predict prolonged MV in patients undergoing coronary artery bypass grafting (CABG) surgery.

Methods

This was a historical cohort study of 4165 adult patients undergoing CABG between January 1996 and December 2016. MV for periods ≥ 12 hours was considered prolonged. Logistic regression was used to examine the relationship between risk predictors and prolonged MV. The variables were scored according to the odds ratio. To build the risk score, the database was randomly divided into 2 parts: development data set (2/3) with 2746 patients and internal validation data set (1/3) with 1419 patients. The final score was validated in the total database and the model’s accuracy was tested by performance statistics. Significance was established at p < 0.05.

Results

Prolonged MV was observed in 783 (18.8%) patients. Predictors of risk were age ≥ 65 years, urgent/emergency surgery, body mass index ≥ 30 kg/m², chronic kidney disease, chronic obstructive pulmonary disease, and cardiopulmonary bypass time ≥ 120 minutes. The area under the ROC curve was 0.66 (95% CI, 0.64-0.68; p<0.001), the Hosmer-Lemeshow chi-square test was χ²: 3.38 (p=0.642), and Pearson’s correlation was r = 0.99 (p<0.001), indicating the model’s satisfactory ability to predict the occurrence of prolonged MV.

Conclusion

Selected variables allowed the construction of a simplified risk score for daily practice, which may classify the patients as having low, moderate, high, and very high risk. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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IJCS

Original Article

Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery

André Luiz Lisboa Cordeiro et al. Livia Freire de Lima Oliveira Thaynã Caribé Queiroz Verena Lourranne Lima de Santana … Thiago Araújo de Melo André Raimundo Guimarães Bruno Prata Martinez

Abstract

Background:

Mechanical ventilation (MV) and extracorporeal circulation (ECC) are associated with a decline in pulmonary mechanics that may affect gas exchange.

Objective:

To evaluate the impact of pulmonary mechanics on MV duration and gas exchange in the postoperative period of cardiac surgery.

Methods:

This was a cohort study in patients undergoing cardiac surgery. All patients underwent evaluation of pulmonary mechanics (static compliance and airway resistance) and arterial blood gas analysis upon admission to the intensive care unit (ICU) and were followed up until extubation and hospital discharge.

Results:

The study included 50 patients (46 women, 52%) with a mean age of 57.5 ± 13.5 years. The MV duration was 7.7 ± 3.0 hours, static compliance was 35.5 ± 9.1 cm H₂O, resistance was 6.0 ± 2.3 cm H₂O, mean length of ICU stay was 2.9 ± 1.1 days, and oxygenation index was 228.0 ± 33.4 mmHg. No significant correlation was found between MV duration and static compliance (p = 0.73), but a strong correlation was found between static compliance and gas exchange (r = 0.8 and p < 0.001).

Conclusion:

Pulmonary mechanics have a strong correlation with gas exchange and a weak correlation with MV duration after cardiac surgery.

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ABC

Case Report

ST Elevation Myocardial Infarction Early After Heart Transplantation

Sérgio Lourenço Madeira et al. Luís Filipe Raposo Márcio Madeira Marta Marques … Maria José Rebocho José Pedro Neves

Introduction

Heart transplantation is the last option to improve survival in end-stage heart failure. Unfortunately, the increased need for organs far outweighs the availability of donors. To overcome this situation and to increase the number of available hearts for transplantation, donor selection criteria were made less stringent ^– . Nowadays, the one-year survival rate after transplantation is close to 90% ^– , with 50% of the patients surviving for more than 10 years. The main factor limiting survival is allograft vasculopathy (AV), which occurs in up to 10% and 50% of the patients at 1-year and 5-year after transplantation, respectively.

ST elevation myocardial infarction (STEMI) is rare in these patients and is even more uncommon shortly after transplantation. Despite being an uncommon manifestation of AV, STEMI is usually related to AV ^, .

[…]

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ABC

Artigo Original

Effect of ventilatory support on functional capacity in patients with heart failure: a pilot study

Eugênia da Silva Lima et al. Cristiano Gonçalves Cruz Fabiane Costa Santos Mansueto Gomes-Neto … Hugo Souza Bittencourt Francisco José Farias Borges dos Reis Roque Aras Armênio Costa Guimarães Erenaldo de Souza Rodrigues-Junior

BACKGROUND: Heart failure (HF) is an important public health problem, of which main clinical symptoms are dyspnea and fatigue. Noninvasive ventilatory support has been used as adjuvant therapy in cardiac rehabilitation in order to improve the functional capacity of patients. OBJECTIVE: To evaluate the functional capacity of patients with HF submitted to ventilatory support. METHODS: We evaluated the sociodemographic information, as well as data on quality of life, blood pressure (BP), peripheral oxygen saturation (SpO2), dyspnea, lactate concentration before and after the 6-minute walk test (6MWT) and the distance walked by patients of both sexes with chronic heart failure (CHF), with left ventricular ejection fraction (LVEF) < 45.0% , randomized in two groups: control and CPAP (the group used CPAP – 10 cmH2O for 30 minutes). RESULTS: A total of 12 patients, of which 8 were males, with CHF functional class II and III (NYHA) participated in the study. The patients had mean LVEF of 35.3 ± 8.7 and mean age was 46.3 ± 10.3 years. When comparing the control group with the CPAP group at the end of the 6th minute, there was a significant difference between the groups regarding SpO2 values (Control: 93.6 ± 1.5 % vs CPAP: 96.1±1.8%; p = 0.027), index of dyspnea (Control: 13.1 ± 1.16 vs CPAP: 11 ± 0.8; p = 0.009), lactate concentration (Control: 3.3 ± 0.7 mmol/l vs CPAP: 2.3 ± 0.5 mmol/l; p = 0.025) and distance walked at the 6MWT (Control: 420.6 ± 73.8 m vs CPAP: 534 ± 89.91 m; p = 0.038). CONCLUSION: The previous use of the CPAP had beneficial effects on SpO2, index of dyspnea, lactate concentration, double product and the distance walked at the 6MWT in patients with CHF when performing the 6MWT.

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ABC

Artigo Original

Application of noninvasive ventilation in acute respiratory failure after cardiovascular surgery

Vera Regina de Morais Coimbra et al. Rodrigo de Almeida Lara Ériko Gonçalves Flores Emília Nozawa … José Octávio Costa Auler Júnior Maria Ignez Zanetti Feltrim

OBJECTIVE: To examine ventilatory response, oxygenation-related, and hemodynamics of patients with hypoxemic acute respiratory failure (ARF) submitted to noninvasive mechanical ventilation (NIV) during the postoperative phase of cardiovascular surgery in order to identify predictive variables of success, and to compare the different types of NIV. METHODS: Seventy patients with hypoxemic ARF were randomized to one of three modalities of NIV – continuous positive airway pressure (CPAP) and ventilation with two pressure levels (PEEP + SP and BiPAP®). Ventilation, oxygenation-related, and hemodynamics variables were analyzed at pre-application, and 3, 6, and 12 hours after the protocol began. RESULTS: Thirteen patients were excluded. Thirty-one patients progressed to independence from ventilatory support and comprised the success group, and 26 required orotracheal intubation and were considered the nonsuccess group. Age, initial heart rate (HR), and respiratory rate (RR) showed elevated levels in the nonsuccess group (p=0.042, 0.029, and 0.002, respectively). A greater number of intraoperative complications were seen in the nonsuccess group (p=0.025). Oxygenation variables increased only in the success group. Among the NIV types, 57.9% of patients in the ventilator group, 57.9% in the two-pressure levels group, and 47.3% in the CPAP group progressed with success. Oxygenation and RR variables showed improvement only in the groups with two pressure levels. CONCLUSION: Patients with hypoxemic ARF in the postoperative stage after cardiovascular surgery showed better oxygenation, RR, and HR during NIV application. In older patients and those with higher baseline RR and HR values, NIV was not sufficient to reverse ARF. The two-pressure level modes showed better results.

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Risk Score for Prolonged Mechanical Ventilation in Coronary Artery Bypass Grafting

Abstract

Background

Objective

Methods

Results

Conclusion

Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

ST Elevation Myocardial Infarction Early After Heart Transplantation

Introduction

Effect of ventilatory support on functional capacity in patients with heart failure: a pilot study

Application of noninvasive ventilation in acute respiratory failure after cardiovascular surgery

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