PURPOSE: Some degree of pulmonary dysfunction (PD) is a common sequelae of cardiac surgery. The purpose of this study was to explore the trajectory of PD from patients’ admission for cardiac surgery to discharge from hospital, a diagnosis of clinically defined pneumonia or death. A standardised diagnostic algorithm from the CDC NNIS was used to confirm the presence of clinically defined pneumonia.
METHODS: An observational repeated measures study of antecedent contributors to the development of pneumonia from the pre, intra, and postoperative period were tracked daily and prospectively in 325 adult cardiac surgical patients (2903 days) at two major metropolitan hospitals in Victoria, Australia. The normative pattern of presentation of PD was mapped and indicators of pneumonia monitored to explore whether the trajectory of pulmonary recovery and factors that indicate the timely identification of patients at risk of pneumonia could be identified systematically.
RESULTS: In this sample PD presented according to distinct length of stay tertiles. As the severity of PD increased so did patients’ length of stay (LOS). When LOS was less than a week (n = 206, 63.4%) patients experienced one or two indicators of PD. When LOS was greater than a week but less than two weeks (n = 95, 29.2%) patients experienced two or three indicators of PD. When LOS was greater than two weeks (n =24, 7.4%) three or four PD indicators were present. This study provides evidence of a pattern of PD that is distinct from pulmonary complications requiring treatment.
CONCLUSIONS: Multiple indicators of PD were evident early in patient recovery for those patients whose LOS was greater than a week. The PD trajectory provides a useful clinical framework for implementing and evaluating the effectiveness of interventions aimed at attenuating or preventing pneumonia.
CLINICAL IMPLICATIONS: Understanding the trajectory of pulmonary dysfunction provides opportunities for further research to determine the effectiveness of pre-emptive rather than reactive practice.
DISCLOSURE: The following authors have nothing to disclose: Rochelle Wynne, Mari Botti, James Tatoulis
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