Predictors and outcomes of postoperative respiratory failure after cardiac surgery.

BACKGROUND: Postoperative respiratory failure after cardiac surgery (CS-PRF) is a devastating complication and its incidence and predictors vary depending on how it is defined and the patient population. AIMS: This study was conducted to determine the incidence, predictors and outcomes of CS-PRF defined as prolonged mechanical ventilation >48 hours and reintubation. METHODS: This is a retrospective chart review of 1257 patients who underwent cardiac surgery between June 2011 and December 2018. The research questions were addressed through bivariate inferential, descriptive and binary logistic regression. RESULTS: The overall incidence of CS-PRF was 15.9% and significant regression predictors included diabetes mellitus (OR = 1.77, P = .001), preoperative renal replacement therapy (OR = 2.07, P = .033), need for intraoperative transfusion (OR = 2.35, P = .000), combined coronary bypass/valvular surgery (OR = 2.61, P = .001) and intra-aortic balloon pump (OR = 3.60, P = .000). CS-PRF patients had increased postoperative blood transfusions (69.5% vs 27.9%, P = .000), reoperation for bleeding (9.0 vs 0.4%, P = .000), pleural effusion (13.5% vs 4.1%, P = .000), pneumonia (33.5% vs 1.6%, P = .000), acute kidney injury (70.9% vs 39.9%, P = .000), atrial fibrillation (42.5% vs 26.3%, P = .000), coma/encephalopathy (21.5% vs 3.3%, P = .000) and cerebrovascular accident (6.0% vs 1.3%, P = .000). They also had longer intensive care (262.1 vs 97.4 hours, P = .000) and hospital lengths of stay (17 vs 8 days, P = .000), and increased in-hospital mortality (17.5% vs 0.4%, P = .000). Survivors of CS-PRF were less likely to be discharged home (38.0% vs 84.4%, P = .000). CONCLUSIONS: Knowledge of predictors for CS-PRF may help identify patients who are at risk for this complication and who may benefit from preventive measures to promote early extubation and to avert reintubation.

Predictors and Outcomes of Acute Kidney Injury after Cardiac Surgery.

A retrospective study was performed to evaluate predictors and outcomes of acute kidney injury (AKI) post-cardiac surgery based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The incidence of AKI post-cardiac surgery was 30.3% for AKI Stage 1, 7.1% for AKI Stage 2, and 7.9% for AKI Stage 3. Smoking history, postoperative acute respiratory failure, and postoperative blood transfusion were predictors of all AKI stages. Hypertension, cardiopulmonary bypass, and postoperative coma/encephalopathy were predictors of higher AKI stages. AKI post-cardiac surgery was significantly associated with poor postoperative outcomes, including prolonged intensive care unit and hospital lengths of stay, lower likelihood to be discharged home, and increased postoperative mortality. AKI is a common complication after cardiac surgery, and knowledge of predictors of post-cardiac surgery AKI helps identify patients at risk.