What is the clinical evidence from this study?

Study design: Cohort. Population: Valve surgery requiring long cardiopulmonary bypass (n=225). Intervention: PaO2/FiO2 and AaDO2/PaO2 measurement. Primary outcome: Correlation of PaO2/FiO2 and AaDO2/PaO2 with ventilation time, ICU stay, and hospital stay (r2 = 0.318 and 0.435 (ventilation time), p=<0.0001).

July 23, 2021Open Access

Postoperative Changes in Pulmonary Function after Valve Surgery: Oxygenation Index Early after Cardiopulmonary Is a Predictor of Postoperative Course

Key Result

PaO2/FiO2 and AaDO2/PaO2 measured two hours after cardiopulmonary bypass correlated with ventilation time (r2=0.318 and 0.435) and predicted early and delayed extubations.

Study Design

Type

Cohort (n=225)

Structured PICO

Do PaO2/FiO2 and AaDO2/PaO2 measured two hours after cardiopulmonary bypass predict ventilation time and length of stay in patients undergoing non-emergency valve surgery?

Population

225 patients undergoing consecutive non-emergency valve surgeries with fast-track cardiac anesthesia requiring long cardiopulmonary bypass (CPB), median age 71.0 years.

Intervention

Measurement of PaO2/FiO2 and AaDO2/PaO2 two hours after cardiopulmonary bypass

Outcome

Correlation of PaO2/FiO2 and AaDO2/PaO2 with ventilation time, intensive care unit (ICU) stay, and hospital stay, and prediction of early (<6 h) and delayed (>24 h) extubations

PaO2/FiO2 and AaDO2/PaO2 measured two hours after cardiopulmonary bypass are useful predictors of ventilation time and length of ICU and hospital stays in patients undergoing valve surgery.

Main Result

Effect estimate: r2 = 0.318 and 0.435 (ventilation time)

p-value: p=<0.0001

Abstract

Objective: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). Methods: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. Results: Median age and EuroSCORE II were 71.0 years (25–75 percentile: 59.5–77.0) and 2.46 (1.44–5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122–193). PaO2/FiO2 and AaDO2/PaO2 significantly deteriorated two hours, but not immediately, after CPB (both p 24 h) were predicted by PaO2/FiO2 (377.2 and 213.1) and AaDO2/PaO2 (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700–0.911 and 0.677–0.859). Conclusions: PaO2/FiO2 and AaDO2/PaO2 two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.

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