Journal of Korean Critical Care Nursing (중환자간호학회지)

Korean Society of Critical Care Nursing (한국중환자간호학회)
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Risk Factors and Clinical Outcomes of Unplanned Reintubation after Planned Extubation in Adult Patients admitted to the Intensive Care Unit after Cardiac Surgery

성인 심장수술 후 중환자실에 입실한 환자의 계획된 발관 후 비계획적 기관 재삽관 위험요인과 임상결과

  • Lee, Ju-Hee (Thoracic & Cardiovascular Surgery Intensive Care Unit, Asan Medical Center) ;
  • Choi, Hye-Ran (Department of Clinical Nursing, University of Ulsan)
  • 이주희 (서울아산병원 흉부외과중환자실) ;
  • 최혜란 (울산대학교 의과대학 임상전문간호학전공)
  • Received : 2022.09.18
  • Accepted : 2022.10.20
  • Published : 2022.10.31
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Abstract

Purpose : This study aimed to identify risk factors for unplanned reintubation after planned extubation and to analyze the clinical outcomes in patients admitted to the intensive care unit after cardiac surgery. Methods : The study examined patients who underwent intubation and planned extubation admitted to the intensive care unit after cardiac surgery between January 1, 2017, and December 31, 2021. The reintubation group comprised 58 patients underwent unplanned reintubation within 7 days of planned extubation. The maintenance group comprised 116 patients who did not undergo reintubation and were matched with the reintubation group using the rational for matching criteria. Data were collected retrospectively from electronic medical records. We used the independent t-test, Mann-Whitney U test, 𝑥2-test, Fisher's exact test, and logistic regression analysis with SPSS/WIN 27.0. Results : The multivariate logistic regression analysis demonstrated that albumin (odds ratio [OR]=0.38, 95% confidence interval [CI]=0.20-0.72), surgery time (OR=1.54, 95% CI=1.20-1.97), PaO2 before extubation (OR=0.85 per 10 mmHg, 95% CI=0.75-0.97), postoperative arrhythmia (OR=2.82, 95% CI=1.22-6.51), reoperation due to bleeding (OR=4.65, 95% CI=1.27-17.07), and postoperative acute renal failure (OR=2.97, 95% CI=1.09-8.04) were risk factors for unplanned reintubation. The reintubation group had a higher in-hospital mortality rate (𝑥2=33.74, p<.001), longer intensive care unit stay (Z=-7.81, p<.001), and longer hospital stay than the maintenance group (Z=-8.29, p<.001). Conclusion : These results identified risk factors and clinical outcomes of unplanned reintubation after planned extubation after cardiac surgery. These findings should be considered when developing and managing an intervention program to prevent and reduce the incidence of unplanned reintubation.

Keywords

References

  1. Mullan CW, Mori M, Pichert MD, Bin Mahmood SU, Yousef S, Geirsson A. United States national trends in comorbidity and outcomes of adult cardiac surgery patients. Journal of Cardiac Surgery. 2020; 35(9):2248-53. https://doi.org/10.1111/jocs.14764
  2. Shoji CY, Figuereido LC, Calixtre EM, Rodrigues CDA, Falcao ALE, Martins PP, et al. Reintubation of patients submitted to cardiac surgery: a retrospective analysis. Revista Brasileira de Terapia Intensiva. 2017;29(2):180-7. https://doi.org/10.5935/0103-507x.20170028
  3. Johns Hopkins medicine. Cardiovascular Surgery [Internet]. [cited 2021 October 25]. Available from: https://www.hopkinsmedicine.org/health/treatment -tests-and-therapies/cardiovascular-surgery
  4. Statistics Korea. Surgical status by medical institution city and province [Internet]. [cited 2021 October 12]. Available from: https://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=TX_35004_A013&conn_path=I2
  5. Engoren M, Buderer NF, Zacharias A, Habib RH. Variables predicting reintubation after cardiac surgical procedures. The Annals of Thoracic Surgery. 1999; 67(3):661-5. https://doi.org/10.1016/s0003-4975(98)01321-6
  6. Rady MY, Ryan T. Perioperative predictors of extubation failure and the effect on clinical outcome after cardiac surgery. Critical Care Medicine. 1999;27(2): 340-7. https://doi.org/10.1097/00003246-199902000-00041
  7. Elmer J, Lee S, Rittenberger JC, Dargin J, Winger D, Emlet L. Reintubation in critically ill patients: procedural complications and implications for care. Critical Care. 2015;19(1):12. https://doi.org/10.1186/s13054-014-0730-7
  8. Hogue Jr CW, Lappas GD, Creswell LL, Ferguson Jr TB, Sample M, Pugh D, et al. Swallowing dysfunction after cardiac operations. Associated adverse outcomes and risk factors including intraoperative transesophageal echocardiography. The Journal of Thoracic and Cardiovascular Surgery. 1995;110(2): 517-22. https://doi.org/10.1016/s0022-5223(95)70249-0
  9. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest. 1997;112(1):186-92. https://doi.org/10.1378/chest.112.1.186
  10. He S, Chen B, Li W, Yan J, Chen L, Wang X, et al. Ventilator-associated pneumonia after cardiac surgery: a meta-analysis and systematic review. The Journal of Thoracic and Cardiovascular Surgery. 2014;148 (6):3148-55. https://doi.org/10.1016/j.jtcvs.2014.07.107
  11. Beverly A, Brovman EY, Malapero RJ, Lekowski RW, Urman RD. Unplanned reintubation following cardiac surgery: incidence, timing, risk factors, and outcomes. Journal of Cardiothoracic and Vascular Anesthesia. 2016;30(6):1523-9. https://doi.org/10.1053/j.jvca.2016.05.033
  12. Jian L, Sheng S, Min Y, Zhongxiang Y. Risk factors for endotracheal re-intubation following coronary artery bypass grafting. Journal of Cardiothoracic Surgery. 2013;8:208. https://doi.org/10.1186/1749-8090-8-208
  13. Yazdanian F, Azarfarin R, Aghdaii N, Faritous SZ, Motlagh SD, Panahipour A. Cardiac variables as main predictors of endotracheal reintubation rate after cardiac surgery. The Journal of Tehran University Heart Center. 2013;8(1):42-7.
  14. Jaber S, Lescot T, Futier E, Paugam-Burtz C, Seguin P, Ferrandiere M, et al. Effect of noninvasive ventilation on tracheal ventilation among patients with hypoxemic respiratiory failure following abdominal surgery: a randomized clinical trial. JAMA. 2016; 315(13):1345-53. https://doi.org/10.1001/jama.2016.2706
  15. Penn IW, Chuang E, Chuang TY, Lin CL, Kao CH. Bidirectional association between migraine and fibromyalgia: retrospective cohort analyses of two populations. BMJ Open. 2019;9(4):e026581. https:// doi.org/10.1136/bmjopen-2018-026581
  16. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996;49(12):1373-9. https://doi.org/10.1016/s0895-4356(96)00236-3
  17. Dyke C, Aronson S, Dietrich W, Hofmann A, Karkouti K, Levi M, et al. Universal definition of perioperative bleeding in adult cardiac surgery. The Journal of Thoracic and Cardiovascular Surgery. 2014;147(5):1458-63. https://doi.org/10.1016/j.jtcvs.2013.10.070
  18. Wang Y, Bellomo R. Cardiac surgery-associated acute kidney injury: risk factors, pathophysiology and treatment. Natural Reviews Nephrology. 2017; 13(11):697-711. https://doi.org/10.1038/nrneph.2017.119
  19. Schortgen F. Fever in sepsis. Minerva Anestesiologica. 2012;78(11):1254-64.
  20. Suh YS, Choi HS., Nho JH, Won SH, Choi JW, Lee JC, et al. Prediction of early postoperative infection after arthroplasty using the C-Reactive Protein level. Journal of the Korean Orthopaedic Associasion. 2012;47(2):133-9. https://doi.org/10.4055/jkoa.2012.47.2.133
  21. Rady MY, Ryan T, Starr NJ. Clinical characteristics of preoperative hypoalbuminemia predict outcome of cardiovascular surgery. Journal of Parenteral and Enteral Nutrition. 1997;21(2):81-90. https://doi.org/10.1177/014860719702100281
  22. Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine. 2008;12(1):1-9. https://doi.org/10.4103/0972-5229.40942
  23. Samuels LE, Kaufman MS, Morris RJ, Promisloff R, Brockman SK. Coronary artery bypass grafting in patients with COPD. Chest. 1998;113(4):878-82. https://doi.org/10.1378/chest.113.4.878
  24. Ried M, Unger P, Puehler T, Haneya A, Schmid C, Diez C. Mild-to-moderate COPD as a risk factor for increased 30-day mortality in cardiac surgery. The Thoracic and Cardiovascular Surgeon. 2010; 58(7):387-91. https://doi.org/10.1055/s-0030-1249830
  25. Branca P, McGaw P, Light R. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest. 2001;119(2):537-46. https://doi.org/10.1378/chest.119.2.537
  26. Elassal AA, Al-Ebrahim KE, Debis RS, Ragab ES, Faden MS, Fatani MA, et al. Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate. Journal of Cardiothoracic Surgery. 2021;16(1):166. https://doi.org/10.1186/s13019-021-01545-4
  27. Cohen AJ, Katz MG, Frenkel G, Medalion B, Geva D, Schachner A. Morbid results of prolonged intubation after coronary artery bypass surgery. Chest. 2000;118(6):1724-31. https://doi.org/10.1378/chest.118.6.1724
  28. Taboada M, Rey R, Martinez S, Soto-Jove R, Miron P, Selas S, et al. Reintubation in the ICU following cardiac surgery: is it more difficult than first-time intubation in the operating room?: a prospective observational study. European Journal of Anaesthesiology. 2020;37(1):25-30. https://doi.org/10.1097/EJA.0000000000001019
  29. Khandelwal N, Dale CR, Benkeser DC, Joffe AM, Yanez III ND, Treggiari MM. Variation in tracheal reintubations among patients undergoing cardiac surgery across Washington state hospitals. Journal of Cardiothoracic and Vascular Anesthesia. 2015; 29(3):551-9. https://doi.org/10.1053/j.jvca.2014.11.009
  30. Hayashi LY, Gazzotti MR, Vidotto MC, Jardim JR. Incidence, indication and complications of postoperative reintubation after elective intracranial surgery. Sao Paulo Medical Journal. 2013;131:158-65. https://doi.org/10.1590/1516-3180.2013.1313440
  31. Terzi N, Lofaso F, Masson R, Beuret P, Normand H, Dumanowski E, et al. Physiological predictors of respiratory and cough assistance needs after extubation. Annals of Intensive Care. 2018;8(1):18. https://doi.org/10.1186/s13613-018-0360-3