Journal article

Publication year: 2022

Pages: 1493-1506

Journal: Canadian Journal of Anesthesia

Volume number: 69

Issue number: 12

ISSN: 0832-610X

eISSN: 1496-8975

Open access status: Green

DOI Link: https://doi.org/10.1007/s12630-022-02319-9

Publisher: Springer

Abstract: 

Purpose Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications.

Methods Four thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored.

Results Prolonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications.

Conclusion In this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors.

Harvard Citation style: Sankar, A., Rotstein, A., Teja, B., Carrier, F., Belley-Cote, E., Bolliger, D., et al. (2022) Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial, Canadian Journal of Anesthesia, 69(12), pp. 1493-1506. https://doi.org/10.1007/s12630-022-02319-9

APA Citation style: Sankar, A., Rotstein, A., Teja, B., Carrier, F., Belley-Cote, E., Bolliger, D., Saha, T., Carmona, P., Sander, M., Shehata, N., Thorpe, K., & Mazer, C. (2022). Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial. Canadian Journal of Anesthesia. 69(12), 1493-1506. https://doi.org/10.1007/s12630-022-02319-9