Universidade Estadual de Campinas, Campinas, SP - Brasil.
Arq Bras Cardiol. 2024 Feb 23;121(2):e20230350. doi: 10.36660/abc.20230350. eCollection 2024.
Static lung compliance, which is seriously affected during surgery, can lead to respiratory failure and extubation failure, which is little explored in the decision to extubate after cardiac surgery.
To evaluate static lung compliance in the postoperative period of cardiac surgery and relate its possible reduction to cases of extubation failure in patients submitted to the fast-track method of extubation.
Patients undergoing cardiac surgery using cardiopulmonary bypass (CPB) at a state university hospital admitted to the ICU under sedation and residual block were included. Their static lung compliance was assessed on the mechanical ventilator using software that uses least squares fitting (LSF) for measurement. Within 48 hours of extubation, the patients were observed for the need for reintubation due to respiratory failure. The level of significance adopted for the statistical tests was 5%, i.e., p<0.05.
77 patients (75.49%) achieved successful extubation and 25 (24.51%) failed extubation. Patients who failed extubation had lower static lung compliance compared to those who succeeded (p<0.001). We identified the cut-off point for compliance through analysis of the Receiver Operating Characteristic Curve (ROC), with the cut-off point being compliance <41ml/cmH2O associated with a higher probability of extubation failure (p<0.001). In the multiple regression analysis, the influence of lung compliance (divided by the ROC curve cut-off point) was found to be 9.1 times greater for patients with compliance <41ml/cmH2O (p< 0.003).
Static lung compliance <41ml/cmH2O is a factor that compromises the success of extubation in the postoperative period of cardiac surgery.
静态肺顺应性在手术过程中会受到严重影响，可导致呼吸衰竭和拔管失败，而这在心脏手术后拔管决策中探讨较少。
评估心脏手术后患者的静态肺顺应性，并探讨其降低与快速脱机方法拔管后发生拔管失败的关系。
纳入在州立大学医院接受体外循环（CPB）心脏手术且在镇静和残留阻滞下入住 ICU 的患者。使用软件通过最小二乘法拟合（LSF）进行测量，在拔管后 48 小时内观察患者因呼吸衰竭而需要重新插管的情况。统计学检验的显著性水平设为 5%，即 p<0.05。
77 例（75.49%）患者成功拔管，25 例（24.51%）患者拔管失败。与成功拔管的患者相比，拔管失败的患者静态肺顺应性更低（p<0.001）。通过受试者工作特征曲线（ROC）分析确定顺应性的截断值，截断值为顺应性<41ml/cmH2O 与更高的拔管失败概率相关（p<0.001）。在多元回归分析中，发现顺应性<41ml/cmH2O 患者的肺顺应性（除以 ROC 曲线截断值）的影响是顺应性≥41ml/cmH2O 患者的 9.1 倍（p<0.003）。
静态肺顺应性<41ml/cmH2O 是心脏手术后患者拔管失败的一个影响因素。
