Dias F S, Milius G, Posenato A A, Palombini D V, Bodanese L C, Petracco J B
Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul.
Arq Bras Cardiol. 1992 Oct;59(4):269-73.
To study the causes of difficulty or impossible weaning of cardiac surgical patients undergoing mechanical ventilation in the postoperative period and their outcome.
Three hundred and forty three consecutive adult patients submitted to open heart surgery were retrospectively studied and classified in three groups: I--patients in mechanical ventilation more than 24 hours; II--patients in mechanical ventilation less than 24 hours and reintubated some time after this period; III--patients successfully extubated in the first 24 hours of ventilation.
The authors were able to identify the following preoperative factors associated with prolonged postoperative ventilation: cardiac failure, pulmonary hypertension, smoking, chronic obstructive pulmonary disease and previous open heart surgery. Significant factors in the immediate postoperative period (1st 24 hours) were: atelectasis, low output syndrome, perioperative myocardial infarction, reoperation for excessive bleeding, pleural effusion and cardiac arrest. This group of patients had a significant increase in nosocomial pneumonia, multiple organ failure (MOF) and surgical mortality.
Pre and postoperative factors were identified associated with prolonged mechanical ventilation in the postoperative period and responsible by significant morbidity as such pulmonary infection, MOF and increase in mortality.
研究心脏外科手术后接受机械通气的患者术后脱机困难或无法脱机的原因及其预后。
对343例连续接受心脏直视手术的成年患者进行回顾性研究，并分为三组：I组——机械通气超过24小时的患者；II组——机械通气少于24小时且在此期间后再次插管的患者；III组——在通气的前24小时内成功拔管的患者。
作者能够确定以下与术后通气时间延长相关的术前因素：心力衰竭、肺动脉高压、吸烟、慢性阻塞性肺疾病和既往心脏直视手术。术后即刻（最初24小时）的重要因素有：肺不张、低心排血量综合征、围手术期心肌梗死、因出血过多再次手术、胸腔积液和心脏骤停。该组患者医院获得性肺炎、多器官功能衰竭（MOF）和手术死亡率显著增加。
已确定术前和术后因素与术后机械通气时间延长相关，并导致诸如肺部感染、MOF和死亡率增加等显著的发病率。
