Risk factors for transient dysfunction of gas exchange after cardiac
                    surgery

Rodrigues, Cristiane Delgado Alves; Moreira, Marcos Mello; Lima, Núbia Maria Freire Vieira; Figueirêdo, Luciana Castilho de; Falcão, Antônio Luis Eiras; Petrucci Junior, Orlando; Dragosavac, Desanka

doi:10.5935/1678-9741.20140103

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Brazilian Journal of Cardiovascular Surgery

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Sumário

ORIGINAL ARTICLES • Rev Bras Cir Cardiovasc 30 (1) • Jan-Mar 2015 • https://doi.org/10.5935/1678-9741.20140103 copy

Risk factors for transient dysfunction of gas exchange after cardiac surgery

Fatores de risco para disfunção transitória da troca gasosa após a cirurgia cardíaca

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events.

Methods:

We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011.

Results:

Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451).

Conclusion:

Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac procedures.

Thoracic Surgery; Postoperative Complications; Risk Factors; Intensive Care Units

Abbreviations, acronyms & symbols
APACHE II	Acute Physiology and Chronic Health Evaluation II
ALI	Acute Lung Injury
ARDS	Acute Respiratory Distress Syndrome
CH	Clinics Hospital
CPB	Cardiopulmonary Bypass
FiO₂	Fraction of inspired oxygen
ICU	Intensive Care Unit
PaO₂	Partial pressure of oxygen
PCWP	Pulmonary capillary wedge pressure
PEEP	Positive end-expiratory pressure
SD	Standard deviation
SIRS	Systemic inflammatory response syndrome
TDGE	Transient Dysfunction of Gas Exchange
UNICAMP	Universidade Estadual de Campinas
VAP	Ventilator-Associated Pneumonia

Procedures performed	n	%
Myocardial revascularization	354	49.4%
Valve exchange	212	29.5%
Correction of aortic aneurysm	68	9.5%
Atrial septal defect or interventricular communication	35	4.9%
Coronary artery bypass grafting combined with valve replacement	17	2.4%
Resection of cardiac tumor	4	0.6%
Pacemaker implant	6	0.8%
Reconstruction of left ventricle	6	0.8%
Pericardial drainage	4	0.6%
Cardiac transplantation	3	0.4%
Other^* * Percentage of total group in parentheses	8	1.1%
	717	100%

TDGE levels	n	%
Absence	77	10.7%
Mild	199	27.8%
Moderate	402	56.1%
Severe	39	5.4%
	717	100%

Preoperative data	Prevalence on			TDGE levels			Test for	Test for Risk Factor
	Sample		Absent	Mild	Moderate	Severe	Association	Significance
	n	%	n	n	n	n	P-value*	P-value**	OR	95% CI
Diabetes mellitus	140	19.5%	7	39	83	11	0.057	0.035	1.49	1.03;2.14
Hypertension	377	52.6%	34	93	224	26	0.022	0.002	1.56	1.17;2.07
Cardiogenic shock	15	2.1%	0	1	11	3	0.019	0.001	5.67	1.92;16.75
Cardiac arrhythmia	26	3.6%	2	7	16	1	0.098	0.738	1.14	0.53;2.45
Congestive heart failure	63	8.8%	7	19	34	3	0.966	0.645	0.89	0.54;1.46
Cardiopulmonary arrest	17	2.5%	1	5	8	3	0.172	0.297	1.68	0.63;4.46
Pneumopathy	68	9.5%	5	17	40	6	0.442	0.15	1.44	0.88;2.37
Pneumonia	12	1.7%	3	2	7	0	0.373	0.405	0.64	0.22;1.85
Deep vein thrombosis	2	0.3%	0	1	1	0	-	-	-	-

Age Classes			TDGE levels				Test for	Test for Risk Factor Significance
			Absent	Mild	Moderate	Severe	Association
	n	%	n	n	n	n	P-value*	P-value**	OR	95%CI
≤44	124	17.3%	26	42	49	7	0.0001	Reference class (baseline)
45-54	152	22.6%	16	55	86	5	0.0001	0.0001	1.59	1.03;2.48
55-64	229	31.9%	21	52	139	17	0.0001	0,0001	2.62	1.72;3.99
65-74	153	21.4%	8	45	91	9	0.0001	0.0001	2.41	1.53;3.81
≥75	49	6.8%	6	5	37	1	0.0001	0.0001	3.00	1.56;5.78
	717	100%

Postoperative data	Prevalence on		TDGE levels				Test for	Test for Risk Factor
	Sample		Absent	Mild	Moderate	Severe	Association	Significance
	n	%	n	n	n	n	P-value*	P-value**	OR	95% CI
Pneumonia	64	8.9%	4	12	37	11	0.0001	0.0005	2.63	1.53;4.53
VAP	4	0.6%	0	0	2	2	0.0420	0.003	19.51	2.75;138.45
Non-invasive mechanical
ventilation	15	2.1%	0	4	10	1	0.5400	0.247	1.85	0.65;5.28
Reintubation	69	9.6%	4	15	45	5	0.2250	0.042	1.69	1.02;2.78
Tracheostomy	26	3.6%	3	6	15	2	0.8460	0.651	1.19	0.55;2.58
Renal replacement therapy	62	8.6%	6	10	36	10	0.0005	0.002	2.34	1.36;4.03
Hemotherapy	247	34.4%	21	60	139	27	0.0001	0.0005	1.72	1.26;2.33
Cardiac arrhythmia	26	3.6%	2	7	12	5	0.0450	0.153	1.79	0.81;3.98

Postoperative data	Prevalence on			TDGE levels			Test for
	Sample		Absent	Mild Moderate		Severe	Association
	n	%	n	n	n	n	P-value*
Death within 48 hours	6	0.8%	0	1	4	1	0.5420
Death after 48 hours	66	9,2%	5	13	40	8	0.0350

Authors’ roles & responsibilities
CDAR	Analysis and/or interpretation of data, final approval of the manuscript, study design, manuscript writing or critical review of its content
MMM	Final approval of the manuscript
NMFL	Analysis and/or interpretation of data, statistical analysis, final approval of the manuscript, study design, manuscript writing or critical review of its content
LCF	Final approval of the manuscript
ALEF	Final approval of the manuscript
OPJ	Final approval of the manuscript
DD	Analysis and/or interpretation of data, final approval of the manuscript, study design, manuscript writing or critical review of its content

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[1] Correspondence address: Cristiane Delgado Alves Rodrigues, Universidade Estadual de Campinas (UNICAMP), Cidade Universitária "Zeferino Vaz", Distrito de Barão Geraldo, Campinas, SP, Brazil - Zip code: 13083-970. E-mail: crist_rodrigues@yahoo.com.br