Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, GRC 29, Pitié-Salpêtrière Hospital, Paris, France.
Neuroradiology Department, CH Sainte-Anne, Paris, France.
J Cardiothorac Vasc Anesth. 2022 Mar;36(3):825-832. doi: 10.1053/j.jvca.2021.07.016. Epub 2021 Jul 10.
The authors aimed to identify risk factors associated with prolonged mechanical ventilation (PMV) after scheduled cardiac surgery under cardiopulmonary bypass (CPB).
A single-center, observational study.
Tertiary hospital.
All adult patients who underwent scheduled cardiac surgery under cardiopulmonary bypass between January 2017 and December 2017.
None.
Among the 568 patients included, 68 (12.0%) presented a PMV. The median ventilation time was 5.7 hours in the group without PMV and 85.2 hours in the group with PMV. A logistic regression found five variables independently associated with the occurrence of PMV: (1) prior cardiac surgery, (2) preoperative congestive heart failure, (3) preoperative creatinine clearance <30 mL/min/1.73 m², (4) intraoperative implantation of extracorporeal membrane oxygenation, and (5) serum lactate >4 mmol/L on admission. A predictive score to allow the authors to anticipate PMV was developed from the regression coefficient of perioperative factors independently associated with PMV. With a threshold of 2/13, the score had a sensitivity of 80.9%, a specificity of 80.5%, a positive predictive value of 37.2%, and a negative predictive value of 96.7%. The score then was validated in a distinct cohort.
The study authors have developed a simple score to predict PMV in patients undergoing cardiac surgery with CPB. This score could allow clinicians to identify a high-risk population that might benefit from specific management upon arrival in the intensive care unit.
作者旨在确定与体外循环（CPB）下择期心脏手术后机械通气时间延长（PMV）相关的危险因素。
单中心、观察性研究。
三级医院。
2017 年 1 月至 2017 年 12 月期间在 CPB 下行择期心脏手术的所有成年患者。
无。
在纳入的 568 例患者中，68 例（12.0%）出现 PMV。无 PMV 组的中位通气时间为 5.7 小时，PMV 组为 85.2 小时。Logistic 回归发现五个变量与 PMV 的发生独立相关：（1）既往心脏手术，（2）术前充血性心力衰竭，（3）术前肌酐清除率<30 mL/min/1.73 m²，（4）术中植入体外膜氧合，和（5）入院时血清乳酸>4 mmol/L。从与 PMV 独立相关的围手术期因素的回归系数中，作者开发了一种预测 PMV 的评分。阈值为 2/13 时，该评分的敏感性为 80.9%，特异性为 80.5%，阳性预测值为 37.2%，阴性预测值为 96.7%。然后在一个独立的队列中验证了该评分。
作者开发了一种简单的评分来预测接受 CPB 心脏手术的患者发生 PMV 的可能性。该评分可帮助临床医生识别出高危人群，这些人群在入住重症监护病房时可能需要特定的管理。
