HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (10) Citing Articles via Google Scholar Google Scholar Articles by Yende, S. Articles by Wunderink, R. Search for Related Content PubMed PubMed Citation Articles by Yende, S. Articles by Wunderink, R.

Causes of Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery^*

^* From the Physician Research Network, Methodist Healthcare University Hospital, Memphis, TN.

Correspondence to: Sachin Yende, MD, 501 Crews Wing, 1265 Union Ave, Memphis, TN 38104; e-mail: yende{at}juno.com

Study objective: To evaluate causes of failure to be extubated (FTE) after coronary artery bypass graft (CABG) surgery.

Design: Prospective observational study.

Setting: Cardiovascular surgical ICU.

Patients: Four hundred patients undergoing CABG surgery. Following surgery, patients were extubated by a standardized respiratory protocol and were assessed at 8, 24, and 48 h. Patients who could not be extubated at 8 h were designated as FTE, and at 24 and 48 h they were labeled as requiring prolonged mechanical ventilation (PMV) > 24 h and PMV > 48 h, respectively.

Measurements and results: One hundred sixty-seven patients (41.75%), 27 patients (6.75%), and 21 (5.25%) patients, respectively, could not be extubated at 8, 24, and 48 h. Depressed level of consciousness was the most common reason for FTE in 58 of 167 patients (34.7%). The main cause of depressed level of consciousness was prolonged sedation due to anesthetic agents (51 patients; 30.5%). Hypoxemia was the most common cause for PMV for > 24 h (15 patients) and PMV > 48 h (13 patients). The causes of hypoxemia were cardiogenic and noncardiogenic pulmonary edema, pneumonia, and "hypoxemia of unknown etiology." Tachypnea due to acid-base disturbances was a reason for FTE and PMV for > 24 h in 27 and 3 patients, respectively. Cardiovascular instability was a rare reason for FTE. Postoperative bleeding was a cause for PMV in 18 patients. Four patients had more than a single reason for FTE at each assessment. Different causes have a variable effect on the duration of mechanical ventilation.

Conclusion: The causes of PMV are heterogeneous, vary with time, and have a variable impact on the duration of mechanical ventilation required after the patient undergoes CABG surgery.

Key Words: coronary artery bypass graft surgery • prolonged mechanical ventilation

This article has been cited by other articles:

				E. H. J. Hulzebos, P. J. M. Helders, N. J. Favie, R. A. De Bie, A. Brutel de la Riviere, and N. L. U. Van Meeteren Preoperative intensive inspiratory muscle training to prevent postoperative pulmonary complications in high-risk patients undergoing CABG surgery: a randomized clinical trial. JAMA, October 18, 2006; 296(15): 1851 - 1857. [Abstract] [Full Text] [PDF]

				N. Serrano, C. Garcia, J. Villegas, S. Huidobro, C. C. Henry, R. Santacreu, M. L. Mora, and for the Epidemiological Project for ICU Research a Prolonged Intubation Rates After Coronary Artery Bypass Surgery and ICU Risk Stratification Score Chest, August 1, 2005; 128(2): 595 - 601. [Abstract] [Full Text] [PDF]

				M. Nirmalan, P. M. Dark, P. Nightingale, and J. Harris Editorial IV: Physical and pharmacological restraint of critically ill patients: clinical facts and ethical considerations Br. J. Anaesth., June 1, 2004; 92(6): 789 - 792. [Full Text] [PDF]

				J. Dunning, J. Au, M. Kalkat, and A. Levine A validated rule for predicting patients who require prolonged ventilation post cardiac surgery Eur. J. Cardiothorac. Surg., August 1, 2003; 24(2): 270 - 276. [Abstract] [Full Text] [PDF]