Duration of dialysis is a significant predictor of prolonged postoperative mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery.
Prolonged mechanical ventilation is reported to correlate with increased risk of mortality after cardiac surgery. We designed the present study to determine the preoperative and intraoperative risk factors that could predict postoperative prolonged mechanical ventilation in dialysis-dependent patients undergoing cardiac surgery with cardiopulmonary bypass. Forty-four dialysis-dependent patients were divided into two groups; patients of group E were tracheally extubated within 24 h after admission to the intensive care unit postoperatively (n = 19) and patients of group L (n = 25) required more than 24 h of mechanical ventilation. All patients received hemofiltration during cardiopulmonary bypass and continuous veno-venous hemodialysis postoperatively. A multiple logistic regression analysis showed that duration of dialysis (>10 yr) and duration of surgery (>8 h) were independent risk factors of prolonged mechanical ventilation (>24 h). On admission to the intensive care unit, Pao2/Fio2 of group L was significantly lower than that of group E (294 +/- 135 versus 415 +/- 99 mm Hg) and the circulatory status of group L was worse than that of group E. The median (interquartile range) duration of intensive care unit stay in group E was 3 (3.00) days, which was significantly shorter than that of group L (5 [2.75] days). It is possible that longer surgery increases the likelihood of cardiac dysfunction and poor oxygenation in patients with a long history of dialysis.
Nakasuji
Masato
M
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan. nksuji@msic.med.osaka-cu.ac.jp
Nishi
Shinichi
S
Nakasuji
Kae
K
Hamaoka
Naoya
N
Ikeshita
Kazutoshi
K
Asada
Akira
A
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D012121:Respiration, Artificial / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors