Koroner arter baypas greftleme cerrahisi geçiren erişkinlerde uzamış mekanik ventilasyonun önbelirleyicileri

Predictors of prolonged mechanical ventilation for adult patients undergoing coronary artery bypass grafting surgery

Nukhet AKOVALI VEZİROĞLU,Aynur CAMKIRAN,PINAR ZEYNELOĞLU,Atilla SEZGİN,Arash PİRAT,Gülnaz ARSLAN

Özet

ÖZET Amaç: Bu çalışmanın amacı koroner arter baypas greftleme (KABG) cerrahisi geçiren hastaların perioperatif verilerini inceleyerek uzamış mekanik ventilasyonun önbelirleyicilerini saptamaktır. Gereç ve Yöntem: Başkent Üniversitesi Klinik Araştırma Kurul onayı alındıktan sonra Aralık 2004 ve Aralık 2007 tarihleri arasında KABG cerrahisi geçiren, mekanik ventilasyon ihtiyacı >24 saat olan hastalar Grup Ie (n=22), 24 saat olan Grup Ideki hastalarda rektal sıcaklık ve O2 satürasyonunda düşme daha sık görüldü (sırasıyla p<0,01, p=0,02). Grup Iin intraoperatif kardiyopulmoner resüsitasyon gereksinimi, intraaortik balon pompası kullanımı, vazopressör ve ultrafiltrasyon ihtiyacının Grup IIden fazla olduğu saptandı (sırasıyla p<0,01, p<0,01, p=0,02 ve p=0,02). Reeksplorasyon gereksinimi Grup Ide fazla bulundu (p<0,01). Postoperatif ilk ekstübasyona kadar geçen dönemde opioid, sedatif ve kas gevşetici kullanımının da Grup Ide fazla olduğu görüldü (sırasıyla p=0,02, p<0,01 ve p=0,01). Grup Ide postoperatif taze donmuş plazma (TDP) ve tam kan kullanımı anlamlı olarak fazla bulundu (sırasıyla p<0,01 ve p=0,03). Hastaların postoperatif sistemik komplikasyon varlığı (Grup I: %35, Grup II: %5,2, p<0,01) ile cerrahi sırasında ve postoperatif 48 saat içindeki mortaliteleri (Grup I: %22,7, Grup II: %2,7, p<0,01) Grup Ide yüksek bulundu. Sonuç: Çalışmamızda KABG sonrası preoperatif SVO varlığı, KPB süresi, intraoperatif O2 satürasyonunda düşme, postoperatif TDP ve sedatif kullanımının çoklu regresyon analizi sonucunda uzamış mekanik ventilasyon için güçlü önbelirleyiciler olduğu saptanmıştır.

Abstract

SUMMARY Objective: The objective of this study was to identify predictors of prolonged mechanical ventilation for those who had coronary artery bypass grafting (CABG) surgery, by evaluating their perioperative data. Material and Method: Five hundred consecutive patients who had CABG surgery between December 2004 and December 2007 were retrospectively evaluated after the approval of Baskent University Clinical Studies Committee. Patients requiring mechanical ventilation for ≥24 hours (n=22) were included in Group I and those requiring ventilation for < 24 hours (n=463) were included in Group II. Results: Subjects perioperative findings as a predictor for prolonged mechanical ventilation were analyzed by univariate and multivariate regression analysis. The presence of chronic renal failure and cerebrovascular accident (CVA) were higher in Group I when compared to Group II (p<0.01). It was also noted that patients in Group I who needed more than twenty-four hours of postoperative mechanical ventilation received higher rates of emergency surgery than patients in Group II. Preoperative blood urea nitrogen, creatinine, aspartate aminotransferase levels were higher, albumin and sodium levels were lower in Group I when compared to Group II (p<0.01, p<0.01, p=0.02, p=0.01, and p<0.01 respectively). Anesthesia, surgery and CPB durations were significantly longer for Group I compared to Group II (p<0.01 for all). Those who needed more than twenty-four hours of mechanical ventilation in Group I had significantly lower rectal temperatures and O2 saturation (p=0.02). The need for intraoperative cardiopulmonary resuscitation, the use of intra-aortic balloon pump, and the need for vasopressors and ultrafiltration were higher in Group I when compared to Group II (p<0.01, p<0.01, p=0.02 and p=0.02 respectively). The need for reexploration was higher in Group I (p<0.01). Also, Group I had higher levels of opioid, sedative and muscle relaxant usage till postoperative fi rst extubation (p=0.02, p=0.01, and p=0.01 respectively). Group I had significantly higher requirements of postoperative fresh frozen plasma (FFP) and whole blood (p<0.01 and p=0.03 respectively). Presence of postoperative systemic complications (Group I: 35%, Group II: 5.2%, p<0.01) along with intraoperative and postoperative mortality rates within forty- eight hours (Group I: 22.7%, Group II: %2.7%, p<0.01), were found to be higher in the group that required mechanical ventilation longer than twenty-four hours. Conclusion: In conclusion, by employing multivariate regression analysis preoperative CVA presence, CPB duration, the decreased levels of intraoperative O2 saturation, post CABG usage of FFP plasma and sedatives wer identified as statistically significant predictors o prolonged mechanical ventilation. Key Words: Coronary artery bypass grafting surgery, prolonged mechanical ventilation