Chest

Chest

Volume 128, Issue 2, August 2005, Pages 595-601
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Clinical Investigations in Critical Care
Prolonged Intubation Rates After Coronary Artery Bypass Surgery and ICU Risk Stratification Score

https://doi.org/10.1378/chest.128.2.595Get rights and content

Objective

To determine prolonged intubation rates among patients undergoing coronary artery bypass graft (CABG) surgery, and to evaluate the ability of the Intensive Care Unit Risk Stratification Score (ICURSS) model to predict these events

Design

Prospective observational study

Setting

A 24-bed ICU in a tertiary referral university hospital

Patients

Five hundred sixty-nine patients undergoing CABG surgery

Interventions

Variables of the ICURSS model were recorded at ICU admission. Extubation was performed according to a standard protocol. Patients remaining intubated within 8 h after ICU admission were designated as having early extubation failure (EEF). The next evaluations at 16, 24, 48, 72, and 96 h designated patients as having a prolonged intubation period (PIP) and prolonged mechanical ventilation (PMV) for 24, 48, 72, and 96 h. The ability of the ICURSS model to predict extubation failure at different cutoff values was measured using the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve

Measurements and results

Prolonged intubation rates were as follows: EEF, 40.2%; PIP, 17.2%; PMV for 24 h, 10.4%; PMV for 48 h, 7.6%; PMV for 72 h, 6.5%; and PMV for 96 h, 6.0%. At every cutoff, the ICURSS showed poor discrimination to predict the failure to be extubated. Calibration was also poor, although some ability to predict both EEF and PMV at ≥ 48 h was shown

Conclusions

Prolonged intubation rates after undergoing CABG surgery in our setting were comparable with those of other reports from institutions where fast-track cardiac anesthesia is currently in practice. In our cohort, the ICURSS was not useful for the prediction of length of intubation

Section snippets

Materials and Methods

A prospective observational cohort study was conducted at our 24-bed medical and surgical ICU to study the outcomes of patients who had undergone CABG surgery. Patients undergoing mixed valve surgery and CABG surgery were excluded. The institutional review board waived the need for informed consent because the variables included in the ICURSS model (Fig 1), 19 had already been used for clinical purposes. These variables were recorded along with other demographic and clinical variables once

Results

A total of 569 patients undergoing either conventional or off-pump CABG surgery were studied. There were 417 male patients and 152 female patients with a mean (± SD) age of 64 ± 10 years. The overall mean and median durations of intubation in all patients were 27.05 and 7 h, respectively. Other baseline patient characteristics are summarized in Table 1

There were eight ICU deaths that were considered to be extubation failure at any cutpoint, and the reintubation rate was found to be < 1.5%. When

Discussion

The two main objectives of our study were to describe the rate of extubation failure as well as to investigate the performance of ICURSS to predict extubation failure in patients following CABG.

In previous years, several scoring systems based on clinical criteria have been proposed to predict failure to wean from mechanical ventilation in postoperative cardiac surgical patients.9, 16, 17 Simultaneously, these previous studies described their rates of extubation failure, and our study has been

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    Copyright © 2005 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.