1995 OPEN FORUM Abstracts
Preoperative And Perioperative Predictors Of Prolonged Intubation Time With Coronary Artery Bypass Graft Patients
Scott Slogic, RRT, Virginia Beggs, ARNP, William Nugent, M.D.. Dartmouth Hitchcock Medical Center, Lebanon, N.H.
Objective.-To identify preoperative and perioperative predictors of prolonged intubation in the CABG patient. Design.-A retrospective analysis of clinical data extracted from patient charts and established hospital data bases. The study cohort consists of 677 patients undergoing isolated CABG between April 1992 and February 1994. Data analyzed included patient demographics and history, angiography results, Charleson score, surgical priority, comorbidity index, intra aortic balloon pump insertion, IV nitroglycerin for management of preoperative cardiac ischemia within 24 hours of surgery, number of anastamoses, IMA graft use, total bypass time, and status at time of discharge. Setting.-Cardiothoracic ICU in a regional teaching hospital. Patients.-677 patients undergoing CABG, representing 91% of all CABG patients during that time period. Patients whose data could not be reconciled and validated from chart review and data base comparisons were excluded from the cohort. Outcome measures.- Total intubation time for each patient from post-op admittance to the CT-ICU until discharge or death. Main results.-Cox proportional hazard models were used to identify variables that had a significant impact on total intubation time. Univariate analysis showed a significant correlation (p< = 0.05) between increased intubation time and increasing age, female sex, pump time > 110 minutes, no IMA used, Charleson score >= 2.0, presence of CHF during index admission, emergent priority, IABP insertion, BSA >= 2.06, presence of treated COPD, ejection fraction >= 44%, left ventricular end diastolic pressure >= 24 cmH20, and number of anastamoses >= 4. Multivariate regression analysis showed a significant (p< = 0.05) correlation between increased intubation time and increasing age (Hazards Ratio=0.44), female sex (HR=0.80), pump time (HR=0.75), IABP insertion (HR=0.51), and presence of treated COPD (HR=0.63). Conclusions.-In a multivariate model, predictors of increased intubation time in the post operative CABG patient include increasing age, female gender, pump time >= 110 minutes, IABP insertion, and the presence of treated COPD. We believe a prediction model can be developed to identify patients with increased risk of prolonged intubation. Potential medical interventions for patients identified as at risk could be then initiated. Prolonged intubation remains one of the most common complications of open heart surgery.