Abstract
Objective: To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. Design: Retrospective analysis. Setting: Tertiary intensive care unit. Participants: Cardiac surgery patients. Interventions: Observational study. Measurements and Main Results: The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. Conclusions: The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
| Original language | English |
|---|---|
| Pages (from-to) | 2709-2716 |
| Number of pages | 8 |
| Journal | Journal of Cardiothoracic and Vascular Anesthesia |
| Volume | 33 |
| Issue number | 10 |
| DOIs | |
| Publication status | Published - Oct 2019 |
Keywords
- cardiac surgery
- intensive care
- mechanical ventilation
- risk factors
- risk score
Cite this
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Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation. / Hessels, Lara; Coulson, Tim G.; Seevanayagam, Siven; Young, Paul; Pilcher, David; Marhoon, Nada; Bellomo, Rinaldo.
In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 33, No. 10, 10.2019, p. 2709-2716.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation
AU - Hessels, Lara
AU - Coulson, Tim G.
AU - Seevanayagam, Siven
AU - Young, Paul
AU - Pilcher, David
AU - Marhoon, Nada
AU - Bellomo, Rinaldo
PY - 2019/10
Y1 - 2019/10
N2 - Objective: To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. Design: Retrospective analysis. Setting: Tertiary intensive care unit. Participants: Cardiac surgery patients. Interventions: Observational study. Measurements and Main Results: The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. Conclusions: The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
AB - Objective: To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. Design: Retrospective analysis. Setting: Tertiary intensive care unit. Participants: Cardiac surgery patients. Interventions: Observational study. Measurements and Main Results: The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. Conclusions: The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.
KW - cardiac surgery
KW - intensive care
KW - mechanical ventilation
KW - risk factors
KW - risk score
UR - http://www.scopus.com/inward/record.url?scp=85065087649&partnerID=8YFLogxK
U2 - 10.1053/j.jvca.2019.03.009
DO - 10.1053/j.jvca.2019.03.009
M3 - Article
VL - 33
SP - 2709
EP - 2716
JO - Journal of Cardiothoracic and Vascular Anesthesia
JF - Journal of Cardiothoracic and Vascular Anesthesia
SN - 1053-0770
IS - 10
ER -