Department of Cardiothoracic-Vascular Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy.
Ann Thorac Surg. 2011 Aug;92(2):528-33. doi: 10.1016/j.athoracsur.2011.02.002. Epub 2011 Apr 8.
Patients with ventilator dependency after cardiac operations may require a tracheostomy. This study determined the hospital and postdischarge outcome in a series of patients who underwent a tracheostomy due to ventilator dependency after cardiac operations.
Medical records of cardiac surgical patients were retrospectively reviewed for preoperative, intraoperative, and postoperative variables, and also prospective follow-up for all-cause mortality. All adult patients treated with tracheostomy due to postoperative ventilator dependency between January 1, 2004, and December 31, 2009, were admitted to the study. Statistical methods included a multivariable logistic regression analysis for hospital mortality and a Kaplan-Meier analysis with multivariable Cox regression model for postdischarge mortality.
The study group included 131 patients. The hospital mortality rate was 49%. The only independent predictor for hospital mortality was the number of fresh frozen plasma units transfused during the hospital stay (6% mortality risk increase per each unit transfused). Survival rate for patients discharged from the hospital was 61% at 1 year, 49% at 2 years, 45% at 3 years, and 34% at 5 years. Factors affecting death after discharge were concomitant postoperative heart failure (hazard ratio, 2.6) and the length of ventilator dependency.
Patients with a respiratory failure without associated heart failure or neurologic dysfunction have a significantly better long-term outcome. Caution should be applied in the use of fresh frozen plasma in patients with postoperative respiratory failure and ventilator dependency requiring a tracheostomy.
心脏手术后依赖呼吸机的患者可能需要进行气管切开术。本研究旨在确定一组因心脏手术后呼吸机依赖而行气管切开术患者的住院和出院后结局。
回顾性分析 2004 年 1 月 1 日至 2009 年 12 月 31 日期间因术后呼吸机依赖而接受气管切开术的心脏外科患者的术前、术中及术后变量，并前瞻性随访所有患者的全因死亡率。所有因术后呼吸机依赖而接受气管切开术的成年患者均纳入本研究。统计学方法包括多变量逻辑回归分析用于医院死亡率，Kaplan-Meier 分析和多变量 Cox 回归模型用于出院后死亡率。
研究组包括 131 例患者。医院死亡率为 49%。唯一的独立预测医院死亡率的因素是住院期间输新鲜冷冻血浆的单位数（每输注 1 个单位，死亡率风险增加 6%）。出院后 1 年、2 年、3 年和 5 年的生存率分别为 61%、49%、45%和 34%。影响出院后死亡的因素包括术后心力衰竭（风险比 2.6）和呼吸机依赖时间。
无合并心力衰竭或神经功能障碍的呼吸衰竭患者具有明显更好的长期结局。对于需要进行气管切开术的术后呼吸衰竭和呼吸机依赖患者，应谨慎使用新鲜冷冻血浆。
