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Prolonged mechanical ventilation after cardiac surgery: substudy of the Transfusion Requirements in Cardiac Surgery III trial |
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| Authors: | Sankar Ashwin Rotstein Alexandra J. Teja Bijan Carrier François Martin Belley-Côté Emilie P. Bolliger Daniel Saha Tarit Carmona Paula Sander Michael Shehata Nadine Thorpe Kevin E. Mazer C. David |
| Affiliation: | 1.Department of Anesthesia, Unity Health Toronto, St. Michael’s Hospital, 30 Bond St., Toronto, ON, M5B 1W8, Canada ;2.Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada ;3.Department of Anesthesiology and Department of Medicine, Division of Critical Care, Centre Hospitalier de l’Université de Montréal; Carrefour de l’innovation et santé des populations, Centre de recherche du CHUM; Department of Anesthesiology and Pain Medicine, Université de Montréal, Montréal, QC, Canada ;4.Department of Medicine, McMaster University, Population Health Research Institute, David Braley Cardiac, Vascular, and Stroke Research Institute, Hamilton, ON, Canada ;5.Clinic for Anaesthesiology, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, University of Basel, Basel, Switzerland ;6.Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, ON, Canada ;7.Department of Anesthesiology and Perioperative Medicine, University Hospital La Fe, Valencia, Spain ;8.Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Giessen, UKGM, Justus-Liebig University Giessen, Giessen, Germany ;9.Departments of Medicine, and Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada ;10.Division of Hematology, Mount Sinai Hospital, Toronto, ON, Canada ;11.Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada ;12.Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, ON, Canada ;13.Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada ;14.Applied Health Research Centre (AHRC), Toronto, ON, Canada ;15.Department of Physiology, University of Toronto, Toronto, ON, Canada ; |
| Abstract: | Purpose Prolonged mechanical ventilation (MV) is a major complication following cardiac surgery. We conducted a secondary analysis of the Transfusion Requirements in Cardiac Surgery (TRICTS) III trial to describe MV duration, identify factors associated with prolonged MV, and examine associations of prolonged MV with mortality and complications. MethodsFour thousand, eight hundred and nine participants undergoing cardiac surgery at 71 hospitals worldwide were included. Prolonged MV was defined based on the Society of Thoracic Surgeons definition as MV lasting 24 hr or longer. Adjusted associations of patient and surgical factors with prolonged MV were examined using multivariable logistic regression. Associations of prolonged MV with complications were assessed using odds ratios, and adjusted associations between prolonged MV and mortality were evaluated using multinomial regression. Associations of shorter durations of MV with survival and complications were explored. ResultsProlonged MV occurred in 15% (725/4,809) of participants. Prolonged MV was associated with surgical factors indicative of complexity, such as previous cardiac surgery, cardiopulmonary bypass duration, and separation attempts; and patient factors such as critical preoperative state, left ventricular impairment, renal failure, and pulmonary hypertension. Prolonged MV was associated with perioperative but not long-term complications. After risk adjustment, prolonged MV was associated with perioperative mortality; its association with long-term mortality among survivors was weaker. Shorter durations of MV were not associated with increased risk of mortality or complications. ConclusionIn this substudy of the TRICS III trial, prolonged MV was common after cardiac surgery and was associated with patient and surgical risk factors. Although prolonged MV showed strong associations with perioperative complications and mortality, it was not associated with long-term complications and had weaker association with long-term mortality among survivors. Study registrationwww.ClinicalTrials.gov (NCT02042898); registered 23 January 2014. This is a substudy of the Transfusion Requirements in Cardiac Surgery (TRICS) III trial. |
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