Diaphragm Dysfunction After Cardiac Surgery: Reappraisal.
J Cardiothorac Vasc Anesth
; 35(11): 3241-3247, 2021 11.
Article
em En
| MEDLINE
| ID: mdl-33736912
ABSTRACT
OBJECTIVES:
The aim of this study was to re-investigate the incidence, risk factors, and outcomes of postoperative diaphragmatic dysfunction (DD) with actual cardiac surgery procedures.DESIGN:
Single-center, retrospective, observational study based on a prospectively collected database.SETTING:
Tertiary care cardiac surgery center.PARTICIPANTS:
Patients who underwent cardiac surgery between January 2016 and September 2019.INTERVENTIONS:
None. MEASUREMENTS AND MAINRESULTS:
The DD group included patients with clinically perceptible diaphragmatic paralysis, which was confirmed by chest ultrasound (amplitude of the diaphragm movement in time-motion mode at rest, after a sniff test). The primary endpoint was the incidence of DD. Among 3,577 patients included, the authors found 272 cases of DD (7.6%). Individuals with DD had more arterial hypertension (64.3% v 52.6%; p < 0.0001), higher body mass index (BMI) (28 [25-30] kg/m2v 26 [24-29] kg/m2; p < 0.0002), and higher incidence of coronary bypass grafting (CABG) (58.8% v 46.6%; pâ¯=â¯0.0001). DD was associated with more postoperative pneumonia (23.9% v 8.7%; p < 0.0001), reintubation (8.8% v 2.9%; p < 0.0001), tracheotomy (3.3% v 0.3%; p < 0.0001), noninvasive ventilation (45.6% v 5.4%; p < 0.0001), duration of mechanical ventilation (five [four-11] hours v four [three-six] hours; p < 0.0001), and intensive care unit and hospital stays (14 [11-17] days v 13 [11-16] days; p < 0.0001). In multivariate analysis, DD was associated with CABG (odds ratio [OR] 1.9 [1.5-2.6]; pâ¯=â¯0.0001), arterial hypertension (OR 1.4 [1.1-1.9]; pâ¯=â¯0.008), and BMI (OR per point 1.04 [1.01-1.07] kg/m2; pâ¯=â¯0.003).CONCLUSIONS:
The incidence of symptomatic DD after cardiac surgery was 7.6%, leading to respiratory complications and increased ICU stay. CABG was the principal factor associated with DD.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Diafragma
/
Procedimentos Cirúrgicos Cardíacos
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article