2007 OPEN FORUM Abstracts
THE EFFECT OF COPD IN OPEN HEART SURGERY PATIENTS
J. Murphy1, J. S. Emberger1, H. Nguyen2
Background: Patients undergoing open heart surgery frequently have chronic lung disease. COPD could be a significant co-morbid factor for patients undergoing open heart surgery. It is well documented that air-trapping caused by COPD can increase work of breathing and patient asynchrony on the ventilator, but there is a lack of literature showing different outcomes between COPD and Non-COPD patients undergoing open heart surgery. We wanted to determine the effects on outcome of patients undergoing open heart surgery in patients who had been treated at home for COPD.
Method: We retrospectively reviewed mechanical ventilation data for patients undergoing open heart surgery in our 8 bed cardiovascular ICU (CVICU) over a 16 month period (January 2006 - April 2007). We identified COPD patients as those treated at home for COPD (receiving COPD breathing medications at home). We collected data including; ventilator days, patient mortality and patients requiring tracheostomy.
Results: Eight hundred ninety three (893) Non-COPD ventilator patients were identified with 1010 ventilator days for 1.1 average ventilator days per patient. One hundred twenty six (126) COPD ventilator patients were identified with 636 ventilator days for 5.0 average ventilator days per patient. Average ventilator days per patient were significantly different (p < 0.001) between the two groups. The mortality rate was significantly different, Non-COPD = 3.5%, COPD = 8.7% (p < 0.001). The percent requiring tracheostomy was significantly different, Non-COPD = 3.9%, COPD = 7.9% (p < 0.001). Table displays the percentage of patients extubated by time in days.
Conclusions: Patients in the CVICU with the co-morbidity of COPD remain on the ventilator about five times longer than those who do not have COPD. Patient with COPD also exhibited a higher mortality rate and higher percentage requiring tracheostomy. Future efforts should focus on optimizing work of breathing, reducing air-trapping and performing timely and appropriate liberation trials for the COPD population in the CVICU to normalize this increased time on the ventilator.