[Prolonged mechanical ventilation following heart surgery]

PURPOSE

To study the causes of difficulty or impossible weaning of cardiac surgical patients undergoing mechanical ventilation in the postoperative period and their outcome.

METHODS

Three hundred and forty three consecutive adult patients submitted to open heart surgery were retrospectively studied and classified in three groups: I--patients in mechanical ventilation more than 24 hours; II--patients in mechanical ventilation less than 24 hours and reintubated some time after this period; III--patients successfully extubated in the first 24 hours of ventilation.

RESULTS

The authors were able to identify the following preoperative factors associated with prolonged postoperative ventilation: cardiac failure, pulmonary hypertension, smoking, chronic obstructive pulmonary disease and previous open heart surgery. Significant factors in the immediate postoperative period (1st 24 hours) were: atelectasis, low output syndrome, perioperative myocardial infarction, reoperation for excessive bleeding, pleural effusion and cardiac arrest. This group of patients had a significant increase in nosocomial pneumonia, multiple organ failure (MOF) and surgical mortality.

CONCLUSION

Pre and postoperative factors were identified associated with prolonged mechanical ventilation in the postoperative period and responsible by significant morbidity as such pulmonary infection, MOF and increase in mortality.