Department of Emergency Medicine, Medical University of Vienna, Austria.
Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
J Clin Anesth. 2021 Sep;72:110309. doi: 10.1016/j.jclinane.2021.110309. Epub 2021 Apr 27.
Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac valve- or coronary artery bypass (CABG) surgery and is associated with increased mortality. While it is known that prolonged postoperative invasive ventilation triggers POAF, the impact of ventilatory settings on POAF development has not been studied yet.
Prospective observational study.
Postoperative Intensive Care Unit.
Patients having undergone elective CABG and/or cardiac valve surgery.
Screening for the development of POAF. Patients' clinical data and postoperative ventilatory settings (driving pressure, controlled pressure above positive endexpiratory pressure (PEEP), respiration rate, and FiO2) were investigated to elucidate their impact on POAF.
Out of 441 enrolled individuals, a total of 192 participants developed POAF (43.5%). We observed that POAF patients received a higher peak driving pressure, and a higher peak respiration rate than non-POAF individuals. Within the multivariate regression model, plateau pressure (adjusted OR 1.199 [1.038-1.661], p = 0.019), driving pressure (adjusted OR 1.244 [1.103-1.713], p = 0.021), and peak respiration rate (adjusted OR 1.206 [1.005-1.601], p = 0.040) proved to be independently associated with the development of POAF. CART analysis revealed a cut-off of ≥17.5 cmHO of plateau pressure, ≥11.5 cmHO of driving pressure and ≥ 17 respirations per minute as high-risk for POAF development.
The ventilatory settings of plateau pressure, driving pressure, and respiration rate after cardiac surgery influence POAF occurrence probability. Optimized postoperative care such as lung-protective ventilation and increased awareness towards postoperative ventilatory efforts should be considered to prevent POAF development and poor patient outcome.
术后心房颤动（POAF）是心脏瓣膜或冠状动脉旁路移植（CABG）手术后的常见并发症，与死亡率增加有关。虽然已知术后长时间的有创通气会引发 POAF，但通气设置对 POAF 发展的影响尚未得到研究。
前瞻性观察研究。
术后重症监护病房。
接受择期 CABG 和/或心脏瓣膜手术的患者。
筛查 POAF 的发生。调查患者的临床数据和术后通气设置（驱动压力、控制压力高于呼气末正压（PEEP）、呼吸频率和 FiO2），以阐明它们对 POAF 的影响。
在纳入的 441 名个体中，共有 192 名参与者发生了 POAF（43.5%）。我们观察到 POAF 患者的峰值驱动压力和峰值呼吸频率高于非 POAF 患者。在多变量回归模型中，平台压（调整后的 OR 1.199 [1.038-1.661]，p=0.019）、驱动压力（调整后的 OR 1.244 [1.103-1.713]，p=0.021）和峰值呼吸频率（调整后的 OR 1.206 [1.005-1.601]，p=0.040）被证明与 POAF 的发展独立相关。CART 分析显示，平台压≥17.5cmH2O、驱动压≥11.5cmH2O 和/或每分钟呼吸≥17 次是 POAF 发展的高风险因素。
心脏手术后的平台压、驱动压和呼吸频率的通气设置影响 POAF 的发生概率。应考虑优化术后护理，如肺保护性通气，并提高对术后通气努力的认识，以预防 POAF 的发展和不良的患者结局。
