New research to support better outcomes after heart bypass surgery has been released by a team of researchers from the UF Departments of Anesthesiology and Cardiothoracic Surgery. Using clinical data from UF Health Shands Hospital, the team developed a preliminary prediction model to identify modifiable factors associated with patients requiring prolonged mechanical ventilation following routine coronary artery bypass grafting (CABG) surgeries.
Their findings are documented in the article “Identifying Factors Associated with Prolonged Mechanical Ventilation Following Isolated Coronary Artery Bypass Grafting: A Retrospective Observational Study,” recently published in Perioperative Care and Operating Room Management. Department of Anesthesiology faculty Joseph AbuRahma, M.D., and Yong G. Peng, M.D., Ph.D., were joined by affiliated faculty member Chris Goldstein, M.D., former fellow Jennifer Bromwell, D.O, former faculty member Penny S. Reynolds, Ph.D., and Professor and Chief of Cardiovascular Surgery Thomas Beaver, M.D., MPH, in this research.
The goal of their research was to develop a preliminary clinical tool for patient management. The Society of Thoracic Surgeons recommends that patients should be extubated within six hours after routine CABG to lower mortality and postoperative complications. Identifying modifiable risk factors for patients could help reduce the need for longer mechanical ventilation.
The retrospective study examined the medical records of 85 patients who underwent elective, isolated CABG between January 2021 and December 2022. Patient information such as time on bypass, opioid use, acid‑base status, and core temperature was used to estimate the likelihood of postoperative mechanical ventilation that exceeded six hours.
They found that 31% of the patients required ventilation for more than six hours, and that base deficit, age, core temperature, and a history of chronic obstructive pulmonary disease (COPD) were the most consistent predictors of prolonged intubation. Patients older than 75, with an increased base deficit (≤ –6 mmol/L), and who were hypothermic (< 36 °C) at the time of discharge to the intensive care unit were found to have the highest predicted probability—over 90 %—of remaining intubated beyond six hours.
Significantly, the researchers noted that “These preliminary results suggest that proactive measures to prevent hypothermia and correct elevated base deficit prior to ICU arrival may decrease postoperative mechanical ventilation times for patients undergoing isolated CABG.” While acknowledging that external validation with a larger cohort is necessary before the model can be widely adopted, they note that their findings have led to proactive changes in patient management at UF Health Shands.
“This project is an excellent example of the cardiac surgical and cardiothoracic anesthesiology services working collaboratively as a team to identify clinical issues and implement appropriate solutions to improve the quality of patient care,” said Dr. Peng.
Congratulations to the authors!
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KEY POINTS
- A sizable number of heart‑bypass patients stay on a breathing machine longer than ideal. In the study, about 1 in 3 patients who had a routine coronary artery bypass needed ventilation for more than six hours after their surgery.
- Certain clues predict those at higher risk. Researchers found that older age, a lower body core temperature, a higher “base‑deficit” (a sign of too much acid in the blood), and a history of chronic obstructive pulmonary disorder are the most telling warning signs.
- Pre‑intensive care unit interventions may help. The team believes that keeping patients warmer and correcting the base deficit before they enter the intensive care unit could shorten the need for prolonged ventilation, which is linked to lower death rates and fewer complications.
- Teamwork is already changing practice. UF Shands Hospital has started adjusting its care routine based on these findings, showing how doctors, surgeons, and anesthesiologists can collaborate to improve patient recovery after heart bypass surgery.