Morbid results of prolonged intubation after coronary artery bypass surgery.
OBJECTIVE
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 FEV(1) (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), FEV(1) (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 FEV(1), 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.
Cohen
A J
AJ
Department of Cardiothoracic Surgery, Wolfson Medical Center, Holon (affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv), Israel. sally@wolfson.health.gov.il
Katz
M G
MG
Frenkel
G
G
Medalion
B
B
Geva
D
D
Schachner
A
A
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000009:adverse effects; D003404:Creatinine / Q000097:blood; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011182:Postoperative Care; D011183:Postoperative Complications; D011788:Quality of Life; D012307:Risk Factors; D013997:Time Factors; D014882:Water-Electrolyte Balance
D003404:Creatinine