Preditores de extubação tardia em pacientes adultos no pós-operatório de cirurgia cardíaca

Abstract

Introduction: Cardiovascular diseases (CVDs) are the leading cause of morbidity and mortality worldwide, and heart surgery (HS) is the treatment indicated for many heart diseases. During the surgical procedure, patients are sedated, anesthetized, placed on invasive mechanical ventilation (IMV), and usually undergo cardiopulmonary bypass (CPB). After HS, delayed extubation (DE) and prolonged IMV are markers of a complicated perioperative course, which predict higher morbidity and mortality. Objective: To identify the factors that are associated with DE in adult patients in the postoperative (PO) period of HS. Material and Methods: This is a longitudinal and observational study, which initially screened 1200 medical records of patients undergoing HS in a public cardiovascular referral hospital in Salvador, Bahia, Brazil. Individuals over 18 years of age, of both sexes, who underwent HS using CPB between February 2021 and June 2022. Results: 1122 patients were analyzed, the mean age was 55.6 ± 14.4 years, with a slight predominance of males (51.5%). The most frequent comorbidities were systemic arterial hypertension (59.4%), valvular disease (54.5%), coronary artery disease (46.6%), rheumatic disease (27.7%), and diabetes mellitus (27.2%). In the DE group, valve replacement surgery (49.3%) was the most frequent, followed by myocardial revascularization (43.7%). In this case series, the median CPB time was 80 minutes, 15 minutes longer than the early extubation (EE) group. In the DE group, the median length of intensive care unit (ICU) stay was 4 days, 1 day longer than the EE group, and the median length of hospital stay was 18 days, 4 days longer than the EE group. There was an association between DE and the following factors: age, chronic kidney disease (CKD), pulmonary hypertension (PH), CPB time, and lactate on ICU admission. There was also an association between DE, longer ICU stay, and longer hospital stay. Conclusion: In the present study, the predictors of DE were: age, CKD, PH, CPB time and serum lactate at ICU admission.