title: Risk factors for prolonged mechanical ventilation following surgery for acute type a aortic dissection.
abstract: BACKGROUND
  The aim of this study was to identify predictors of prolonged mechanical ventilation (PMV) following surgery for acute type A aortic dissection (AAAD) and to assess the influence of this complication on clinical outcomes.
  
  
  RESULTS
  A total of 243 patients underwent emergency surgery for AAAD in the period of 1997-2006. Ten patients died within 48 h after surgery. The remaining 233 patients were divided into 2 groups according to the duration of mechanical ventilation; less than 48 h (group A: n=149) or 48 h or longer (group B; n=84). Multivariate analysis was used to identify predictors of PMV. Short and late outcomes were compared between groups. Multivariate analysis showed that shock (systolic BP <90 mmHg; p=0.007), postoperative renal dysfunction (creatinine >2.0 mg/dl; p=0.016), coronary artery bypass grafting (CABG) (p=0.017), and limb ischemia (p=0.044) were independent predictors of PMV. There was no significant difference in in-hospital mortality (group A, 2.7% vs group B, 3.6%) or 5-year survival (group A, 85.9% vs group B, 76.8%).
  
  
  CONCLUSIONS
  Shock, limb ischemia, CABG, and postoperative renal dysfunction increase the risk for PMV. Knowing the predictors of PMV should help optimize postoperative management of these patients.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Omiya-ku, Saitama, Japan. kimura-n@omiya.jichi.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Masashi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Koji
authors.initials: K
authors.lastname: Kawahito
authors.forename: Masamitsu
authors.initials: M
authors.lastname: Sanui
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000208:Acute Disease; D000368:Aged; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors