Morbid results of prolonged intubation after coronary artery bypass surgery

Objectives: This study evaluated the morbid results of prolonged intubation after coronary artery bypass grafting (CABG). Methods: Over 30 months, 66 of 1,112 patients undergoing CABG required prol onged intubation. They were matched with 66 patients who did not require pr olonged intubation. Preoperative and operative variables were evaluated to determine which would predict prolonged intubation. The postoperative cours es were then compared to evaluate the effect of prolonged intubation. The s tudy population was divided into three groups: these who underwent early ex tubation, but required reintubation (n = 24); those who required initial pr olonged intubation, hut no reintubation (n = 22); and those who required in itial prolonged intubation and reintubation (n = 20). Results: Univariate analysis revealed unstable angina (p = 0.037), elevated creatinine (p = 0.001), reduced FEV1 (p = 0.019), longer cardiopulmonary b ypass time (p = 0.009), and a greater positive fluid balance at 24 h (p = 0 .0001) as predictors of postoperative prolonged intubation, h Multivariate regression analysis revealed elevated creatinine (p = 0.011), FEV1 (p = 0.0 22), and fluid balance (p 0.001) as predictors of prolonged intubation. The study population had longer ICU and hospital stays (p = 0.0001), with more infectious complications (p = 0.0001) and higher mortality (p = 0.001). In the subgroups of the study population, patients not requiring reintubation had shorter ICU (p = 0.001) and hospital stays (p = 0.0001), fewer infecti ous complications (p = 0.0001), and reduced mortality (p = 0.0001). Conclusions: Patients undergoing CABG with reduced FEV1, renal failure, and positive fluid balance 24 h postoperatively are at risk for prolonged intu bation. Prolonged intubation results in significant acute and midterm morbi dity and mortality. Early extubation followed by reintubation further incre ases morbidity and mortality rates in these patients.