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Abstract: Poster Presentations |

Respiratory Failure After Cardiovascular Surgery: Is Tracheostomy the Solution? FREE TO VIEW

Peter A. Walts, MD; Sudish C. Murthy, MD, PhD; Jean-Pierre Yared, MD; Eugene H. Blackstone, MD; Thomas W. Rice, MD; Malcolm M. DeCamp, MD
Author and Funding Information

Cleveland Clinic Foundation, Cleveland, OH


Chest


Chest. 2003;124(4_MeetingAbstracts):154S. doi:10.1378/chest.124.4_MeetingAbstracts.154S
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Abstract

PURPOSE:  To 1) determine risk factors for death when respiratory failure develops following cardiovascular surgery, 2) identify predictors of tracheostomy, and 3) define the utility of tracheostomy in this setting.

METHODS:  From 1998 to 2001, 846 of 12,928 patients (6.5%) who underwent cardiovascular surgery required postoperative ventilatory support ≥ 72 hours. Their preoperative, intraoperative, and intensive care unit (ICU) admission data were analyzed for factors associated with time-related competing risks of tracheostomy and death before tracheostomy. Risk-adjusted expected mortality was compared to observed mortality after tracheostomy.

RESULTS:  At 7, 14, and 30 days, mortality was 11%, 15%, and 21%; tracheostomy frequency was 8%, 16%, and 21%. Risk factors for death without tracheostomy included long aortic clamp time (P=.001), acidosis (P<.0001), hypotension (P<.0001), lower cardiac index (P=.008), and need for vasopressin (P<.0001) at ICU admission. Predictors of tracheostomy were extremes of age (older, P<.0001; younger, P=.03), chronic obstructive pulmonary disease (P=.01), worse left ventricular function (P=.02), longer cardiopulmonary bypass time (P=.001), mitral valve replacement (P=.03), and aortic surgery (P=.03). Survival after tracheostomy (89%, 75%, and 32% at 14 and 30 days and 24 months) was worse than expected, based on status at ICU admission (91%, 85%, and 65% at these same intervals; figure).CONCLUSIONS: Respiratory failure following cardiovascular surgery portends an ominous outcome.

CLINICAL IMPLICATIONS:  Worse-than-expected survival after tracheostomy suggests that it may not prevent mortality from respiratory failure, but rather identify a subset of patients less able to tolerate initial surgical stresses and the subsequent postoperative course.

DISCLOSURE:  S.C. Murthy, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM


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