title: Prolonged mechanical ventilation after CABG: risk factor analysis.
abstract: OBJECTIVE
  Prolonged ventilation (PV) after coronary artery bypass graft (CABG) surgery is a common postoperative complication. Preoperative and operative parameters were evaluated in order to identify the patients at risk for prolonged ventilation postoperatively in coronary artery bypass graft (CABG) patients.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  Research and training hospital, single institution.
  
  
  METHODS
  The authors analyzed the prospectively collected data of 830 on- and off-pump coronary bypass patients.
  
  
  METHODS
  The relationships of PV (>24 hours) with preoperative and operative parameters were evaluated with logistic regression analysis.
  
  
  RESULTS
  Forty-six patients (5.6%) required PV postoperatively. Hospital mortality was significantly higher in this group (45.7% v 4.0%; p = 0.0001). Univariate analysis showed that these patients were older (65.6±9.3 v 60.4±9.9; p = 0.001), had higher incidences of cerebrovascular disease (21.7% v 10.5%; p = 0.032), advanced ASA (58.7% v 41.8%; p = 0.026) and NYHA classes (32.6% v 12.2%; p = 0.001), and chronic renal dysfunction (20.0% v 4.0%; p = 0.0001). Concomitant procedures were more commonly performed in these patients (30.4% v 7.8%; p = 0.0001), and total durations of perfusion were longer (147.2±69.1 v 95.7±33.9 minutes; p = 0.0001). In regression analysis, advanced NYHA class (odds ratio = 8.2; 95% CI = 1.5-43.5; p = 0.015), chronic renal dysfunction (odds ratio = 7.7; 95% CI = 1.3-47.6; p = 0.027), and longer perfusion durations (p = 0.012) were found to be independently associated with delayed weaning from the ventilator. Every 1-minute increase over 82.5 minutes of cardiopulmonary bypass increased risk of delayed extubation by 3.5% (95% CI = 0.8%-6.4%).
  
  
  CONCLUSIONS
  Postoperative prolonged ventilation is associated with advanced NYHA class, chronic renal dysfunction and longer perfusion times in CABG patients.
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey. Electronic address: fgumus@hotmail.com.
authors.forename: Funda
authors.initials: F
authors.lastname: Gumus
authors.affiliation: Department of Cardiovascular Surgery, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Adil
authors.initials: A
authors.lastname: Polat
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Yektas
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Totoz
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Bagci
authors.affiliation: Department of Cardiovascular Surgery, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Erentug
authors.affiliation: Department of Anesthesia and Reanimation, Bagcilar Research and Training Hospital, Istanbul, Turkey.
authors.forename: Aysin
authors.initials: A
authors.lastname: Alagol
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000009:adverse effects / Q000639:trends*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000009:adverse effects / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: CABG; coronary artery surgery; delayed extubation; postoperative ventilation; risk factors