Department of Infectious Diseases, Leiden University Medical Center, Leiden University, Leiden, Netherlands; Roslin Institute, University of Edinburgh, Edinburgh, United Kingdom.
Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, Netherlands.
Ann Thorac Surg. 2023 Dec;116(6):1161-1167. doi: 10.1016/j.athoracsur.2023.01.041. Epub 2023 Feb 18.
An asymptomatic respiratory viral infection during cardiac surgery could lead to pulmonary complications and increased mortality. For elective surgery, testing for respiratory viral infection before surgery or vaccination could reduce the number of these pulmonary complications. The aim of this study was to investigate the association between influenzalike illness (ILI) seasons and prolonged mechanical ventilation and inhospital mortality in a Dutch cohort of adult elective cardiac surgery patients.
Cardiac surgery patients who were admitted to the intensive care unit between January 1, 2014, and February 1, 2020, were included. The primary endpoint was the duration of invasive mechanical ventilation in the ILI season compared with baseline season. Secondary endpoints were the median Pao to fraction of inspired oxygen ratio on days 1, 3, and 7 and postoperative inhospital mortality.
A total of 42,277 patients underwent cardiac surgery, 12,994 (30.7%) in the ILI season, 15,843 (37.5%) in the intermediate season, and 13,440 (31.8%) in the baseline season. No hazard rates indicative of a longer duration of invasive mechanical ventilation during the ILI season were found. No differences were found for the median Pao to fraction of inspired oxygen ratio between seasons. However, inhospital mortality was higher in the ILI season compared with baseline season (odds ratio 1.67; 95% CI, 1.14-2.46).
Patients undergoing cardiac surgery during the ILI season were at increased risk of inhospital mortality compared with patients in the baseline season. No evidence was found that this difference is caused by direct postoperative pulmonary complications.
心脏手术期间无症状的呼吸道病毒感染可导致肺部并发症和死亡率增加。对于择期手术，术前或接种疫苗时检测呼吸道病毒感染可减少这些肺部并发症的发生。本研究旨在调查荷兰成人择期心脏手术患者队列中流感样疾病（ILI）季节与延长机械通气和住院内死亡率之间的关系。
纳入 2014 年 1 月 1 日至 2020 年 2 月 1 日期间入住重症监护病房的心脏手术患者。主要终点是 ILI 季节与基线季节相比，侵入性机械通气的持续时间。次要终点是第 1、3 和 7 天的 PaO2 与吸入氧分数比值的中位数和术后住院内死亡率。
共有 42277 例患者接受了心脏手术，其中 12994 例（30.7%）在 ILI 季节，15843 例（37.5%）在中间季节，13440 例（31.8%）在基线季节。未发现 ILI 季节期间侵入性机械通气持续时间延长的危险率。各季节间 PaO2 与吸入氧分数比值的中位数无差异。然而，ILI 季节的住院内死亡率高于基线季节（比值比 1.67；95%CI，1.14-2.46）。
与基线季节相比，接受心脏手术的患者在 ILI 季节住院内死亡率增加。没有证据表明这种差异是由术后直接肺部并发症引起的。
