Medicine of the Future in America

Canadian Neighbor Pharmacy: Prolonged Intubation Rates After Coronary Artery Bypass Surgery and ICU Risk Stratification Score

Coronary artery bypass graftHength of stay in the ICU following coronary artery bypass graft (CABG) surgery has been substantially shortened during the past decade, thus reflecting the current trend for what is called fast-track cardiac anesthesia (FTCA). The efforts of physicians to ensure early extubation of patients are supporting this policy in most ICUs, and a vast majority of patients are successfully extubated within 6 to 8 h after the procedure. However, despite this aim, a large number of patients requiring mechanical ventilation still remain in the ICU for > 24 or 48 h, The appropriate identification of these patients could be of interest for planning ICU resources when the patient enters the unit.

Although the exact definitions for either early extubation failure (EEF) or prolonged mechanical ventilation (PMV) can be controversial, both situations occur frequently after cardiac surgery. The importance of specifically defining EEF and PMV after CABG surgery may be of interest, because the time intervals following surgery may be associated with different reasons, related in turn with different causes, risk factors, and outcomes.

In addition, different scoring systems to predict weaning failure after cardiac surgery have been proposed.’ The main finding from these studies has been that postoperatively collected data using established scoring systems, either general or specific, as well as documented events of high clinical impact for risk assessment and quality control are reliable predictors of prolonged ventilation. If you are going to undergo medical practice but first of all decide to collect the information about diseases you’d better to visit Canadian Neighbor Pharmacy.

Among the more specific models intended to predict complications following cardiac surgery, morbidity prediction after CABG procedures has been widely studied by Higgins and colleagues. They proposed the ICU Risk Stratification Score (ICURSS), also currently known as the Cleveland Score, which was intended to predict both ICU mortality and morbidity after CABG surgery at the time of ICU admission. The ICURSS is a well-known model that includes the following 13 variables: age; body surface area; number of previous cardiac operations; history of previous operation or angioplasty for peripheral vascular disease; preoperative serum creatinine and albumin levels; number of minutes using cardiopulmonary bypass; the use of an intraaortic balloon pump after the cardiopulmonary bypass; and, at ICU admission, heart rate, cardiac index, central venous pressure, arterial bicarbonate level, and the alveolar-arterial oxygen pressure gradient (in millimeters of mercury) [Fig 1].

The aim of our study was to present rates of extubation failure among patients undergoing CABG surgery and to evaluate the ability of the ICURSS at the time of ICU admission to predict these events. Though PMV in cardiac surgical patients can be considered to be due to postoperative complications, our hypothesis was that good agreement between the failure to be extubated at defined time points and morbidity predictions from the ICURSS would explain the weaning failure rates in patients after CABG surgery at our institution.

Fig-1

Figure 1. The ICURSS in patients admitted to the ICU after coronary bypass surgery. Preoperative values and those acquired at ICU admission are listed on the left. Once the unique appropriate condition has been selected from each item, points from the corresponding values at the top are added. The ICURSS value is given by the total number of points from the 13 items. BSA = body surface area; CABG = coronary artery bypass graft; IABP = intraaortic balloon pump; Y = yes; N = no. Adapted from Higgins et al.

This entry was posted in Bypass and tagged calibration, cardiac surgery, coronary artery bypass grafting, discrimination, extubation failure, goodness-of-fit test, Hosmer-Lemeshow x2 statistic, ICU, ICU risk stratification score, mechanical ventilation, receiver operating characteristic curve, weaning.
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