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Title: Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation.
Austin Authors: Hessels, Lara;Coulson, Tim G ;Seevanayagam, Siven ;Young, Paul;Pilcher, David;Marhoon, Nada ;Bellomo, Rinaldo 
Affiliation: Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
Centre of Integrated Critical Care, University of Melbourne, Melbourne, Australia
Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand
School of Medicine, University of Melbourne, Melbourne, Australia
Department of Intensive Care, Alfred Hospital, Melbourne, Australia
Cardiac Surgery
Data Analytics Research and Evaluation (DARE) Centre
Intensive Care
Issue Date: Oct-2019
Date: 2019-03-08
Publication information: Journal of Cardiothoracic and Vascular Anesthesia 2019; 33(10): 2709-2716
Abstract: 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. Retrospective analysis. Tertiary intensive care unit. Cardiac surgery patients. Observational study. 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. 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.
DOI: 10.1053/j.jvca.2019.03.009
ORCID: 0000-0002-1650-8939
Journal: Journal of Cardiothoracic and Vascular Anesthesia
PubMed URL: 31072706
Type: Journal Article
Subjects: cardiac surgery
intensive care
mechanical ventilation
risk factors
risk score
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