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Morbid Results of Prolonged Intubation After Coronary Artery Bypass Surgery^*

^* From the Department of Cardiothoracic Surgery (Drs. Cohen, Katz, Frenkel, Medalion, and Schachner) and the Division of Statistics (Ms. Geva), Wolfson Medical Center, Holon (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Israel.

Correspondence to: Amram J Cohen, MD, FCCP, Department of Cardiovascular Surgery, Wolfson Medical Center, Holon 58100 Israel; e-mail: sally{at}wolfson.health.gov.il

Objectives: This study evaluated the morbid results of prolonged intubation after coronary artery bypass grafting (CABG).

Methods: Over 30 months, 66 of 1,112 patients undergoing CABG required prolonged intubation. They were matched with 66 patients who did not require prolonged intubation. Preoperative and operative variables were evaluated to determine which would predict prolonged intubation. The postoperative courses were then compared to evaluate the effect of prolonged intubation. The study population was divided into three groups: those who underwent early extubation, but required reintubation (n = 24); those who required initial prolonged intubation, but no reintubation (n = 22); and those who required initial prolonged intubation and reintubation (n = 20).

Results: Univariate analysis revealed unstable angina (p = 0.037), elevated creatinine (p = 0.001), reduced FEV₁ (p = 0.019), longer cardiopulmonary bypass time (p = 0.009), and a greater positive fluid balance at 24 h (p = 0.0001) as predictors of postoperative prolonged intubation. Multivariate regression analysis revealed elevated creatinine (p = 0.011), FEV₁ (p = 0.022), and fluid balance (p = 0.001) as predictors of prolonged intubation. The study population had longer ICU and hospital stays (p = 0.0001), with more infectious complications (p = 0.0001) and higher mortality (p = 0.001). In the subgroups of the study population, patients not requiring reintubation had shorter ICU (p = 0.001) and hospital stays (p = 0.0001), fewer infectious complications (p = 0.0001), and reduced mortality (p = 0.0001).

Conclusions: Patients undergoing CABG with reduced FEV₁, renal failure, and positive fluid balance 24 h postoperatively are at risk for prolonged intubation. Prolonged intubation results in significant acute and midterm morbidity and mortality. Early extubation followed by reintubation further increases morbidity and mortality rates in these patients.

Key Words: coronary artery bypass grafting • extubation • prolonged intubation • reintubation

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