Development and Validation of a Predictive Score for Prolonged Mechanical Ventilation After Cardiac Surgery.

OBJECTIVES

The authors aimed to identify risk factors associated with prolonged mechanical ventilation (PMV) after scheduled cardiac surgery under cardiopulmonary bypass (CPB).

DESIGN

A single-center, observational study.

SETTING

Tertiary hospital.

PARTICIPANTS

All adult patients who underwent scheduled cardiac surgery under cardiopulmonary bypass between January 2017 and December 2017.

INTERVENTIONS

None.

MEASUREMENT AND MAIN RESULTS

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.

CONCLUSIONS

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.