Rady and Ryan identified perioperative risk factors associated with extubation failure following cardiac surgery. Extubation failure involves the need to reintubate and mechanically ventilate a patient after having successfully weaning. The authors are from the Mayo Clinic Scottsdale and Cleveland Clinic Foundation.
Factors associated with extubation failure:
(1) age >= 65 years
(2) inpatient status prior to surgery
(3) arterial vascular disease
(4) chronic obstructive pulmonary disease (COPD) or asthma
(5) pulmonary hypertension (preoperative mean pulmonary arterial pressure > 25 mm Hg)
(6) severe left ventricular dysfunction (ejection fraction < 35%)
(7) cardiac shock
(8) hematocrit <= 34%
(9) BUN >= 24 mg/dL
(10) serum albumin <= 4.0 g/dL
(11) systemic oxygen delivery <= 320 mL/min per meter square
(12) redo operation (history of prior operation on the heart or thoracic aorta)
(13) surgical procedure involving the thoracic aorta
(14) cardiopulmonary bypass time >= 120 minutes
(15) transfusion of >= 10 units of blood products (red blood cells and platelets; FFP not mentioned)
|
Factor |
Relative Odds Ratio |
95% CI |
p value |
|
age |
1.31 |
1.12 – 1.53 |
0.0008 |
|
inpatient |
1.39 |
1.15 – 1.68 |
0.0005 |
|
arterial vascular disease |
1.26 |
1.06 – 1.48 |
0.007 |
|
COPD/asthma |
1.64 |
1.28 – 2.07 |
0.0001 |
|
pulmonary hypertension |
1.19 |
1.01 – 1.39 |
0.01 |
|
left ventricular dysfunction |
1.27 |
1.05 – 1.53 |
0.01 |
|
cardiac shock |
2.54 |
1.56 – 4.02 |
0.0001 |
|
hematocrit |
1.38 |
1.14 – 1.68 |
0.001 |
|
BUN |
1.27 |
1.07 – 1.50 |
0.006 |
|
serum albumin |
1.24 |
1.04 – 1.49 |
0.02 |
|
systemic oxygen delivery |
1.27 |
1.07 – 1.52 |
0.007 |
|
redo operation |
1.47 |
1.25 – 1.74 |
< 0.0001 |
|
thoracic aorta surgery |
1.92 |
1.47 – 2.49 |
< 0.0001 |
|
bypass time |
1.23 |
1.04 – 1.44 |
0.02 |
|
blood products |
1.87 |
1.56 – 2.24 |
< 0.0001 |
from Table 3, page 344
Specialty: Pulmonology, Surgery, general, Surgery, orthopedic
