Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
Division of Intensive Care Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
PLoS One. 2023 May 11;18(5):e0285526. doi: 10.1371/journal.pone.0285526. eCollection 2023.
To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB).
This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression.
A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support.
Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not.
确定与体外循环（CPB）脱机后延长心血管药物支持相关的潜在可改变的危险因素。
这是在 2016 年 8 月至 2017 年 7 月期间在一家专门的心脏外科机构中进行的两项前瞻性队列研究的二次分析，纳入了接受 CPB 心脏手术的成年患者。CPB 分离后 24 小时内需要至少一种血管加压药或一种正性肌力药定义为延长心血管药物支持。通过多变量逻辑回归从基线特征和围手术期事件中确定危险因素。
共纳入 247 例患者，其中 98 例（39.7%）发生了延长的药物支持。多变量分析显示，左心室射血分数≤30%（OR 9.52，95%置信区间（CI）1.14；79.25）、收缩压肺动脉压（sPAP）升高>30 且≤55mmHg（中度）（OR 2.52，CI 1.15；5.52）和 sPAP>55mmHg（重度）（OR 8.12，CI 2.54；26.03）以及术后 24 小时内的累积液体平衡（OR 1.76，CI 1.32；2.33）与延长的心血管药物支持的发展独立相关。
CPB 心脏手术后延长心血管药物支持很常见。严重的左心室收缩功能障碍、术前肺动脉高压和术后液体超负荷是危险因素。需要进一步研究以探讨这些危险因素是否可以改变。
