RESUMO
Reintubation in patients after cardiac surgery is associatedwith undesirable consequences. The purpose of the present study was to identify variables that could predict reintubation necessity in this group of patients. We performed a prospective study in 1000 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass. The patients who required reintubation after extubation were compared with patients not requiring reintubation regarding demographic and preoperative clinical variables, including postoperative complications and in-hospital mortality. Postoperatively, 26 [2.6%] of the 1000 patients studied required reintubation due to respiratory, cardiac, or neurological reasons. Advanced age and mainly cardiac variables were determined as univariate infra- and postoperative predictors of reintubation [all p values < 0.05]. Multiple logistic regression analysis revealed lower preoperative [p = 0.014; OR = 3.00, 95% CI: 1.25 - 7.21], and postoperative ejection fraction [p = 0.001; OR = 11.10, 95% CI: 3.88 - 31.79], valvular disease [p = 0.043; OR = 1.84, 95%CI: 1.05 - 3.96], arrhythmia [p = 0.006; OR = 3.84, 95%CI: 1.47 - 10.03], and postoperative infra-aortic balloon pump requirement [p = 0.019; OR = 4.20, 95%CI: 1.26 - 14.00] as the independent predictors of reintubation. These findings reveal that cardiac variables are more common and significant predictors of reintubation after cardiac surgery in adult patients than are respiratory variables. The incidence of this complication, reintubation, is low, although it could result in significant postoperative morbidity and mortality
RESUMO
Obesity is a common risk factor for morbidity and mortality after cardiac surgery. However, the relationship between obesity and postoperative risk has not been fully defined. A prospective study of 1015 consecutive patients undergoing isolated coronary artery bypass grafting [CABG] was carried out. Body mass index [BMI] was used as the measure of obesity and was categorized as normal weight [BMI=20-25] and obese [BMI > 25 and < 35]. The preoperative, operative, and postoperative risk factors as well as the complication and in-hospital death rates were compared between the two groups. Of the 1015 patients, 40% had a normal weight and 49% were obese. Compared with the normal-weight group, the obese group had a significantly higher incidence of diabetes mellitus [P=0.007] and lower arterial partial pressure of oxygen [PaO2] [P=0.03]. The normal-weight patients had a higher New York Heart Association [NYHA] Functional Class [P=0.03] and were at a higher risk for emergent surgery [P=0.003] or reoperation [P=0.002]. Among the postoperative complications, respiratory complications [P=0.027] were more frequent in the obese patients. The duration of mechanical ventilation [P=0.001], the incidence of arrhythmia [P=0.011], low cardiac output syndrome [P=0.001], reintubation [P=0.001], and neurological complications [P=0.003] were significantly higher in the normal-weight patients. Obesity was associated with a lower risk of reoperation for bleeding [P=0.032]. There were no significant differences in infective complications, length of intensive care unit [ICU] stay, total length of stay in hospital, and operative mortality between the groups. In the patients undergoing isolated CABG procedures, obesity did not increase the risk of operative mortality and morbidity with the exception of respiratory complications. The normal body weight patients were at a higher risk for complications than were the obese patients. Therefore, obese patients may safely undergo CABG without previous weight reduction if due attention is paid to minimize respiratory complications