Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective
Objective: We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements. Methods: A retrospective, single-center, and observational analysis of postoperative cardiac surgery patient...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S266627362400038X |
| _version_ | 1797202981593022464 |
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| author | Thomas F. O'Shea, MD Lynze R. Franko, MD Dane C. Paneitz, MD, MPH Kenneth T. Shelton, MD Asishana A. Osho, MD, MPH Hugh G. Auchincloss, MD, MPH |
| author_facet | Thomas F. O'Shea, MD Lynze R. Franko, MD Dane C. Paneitz, MD, MPH Kenneth T. Shelton, MD Asishana A. Osho, MD, MPH Hugh G. Auchincloss, MD, MPH |
| author_sort | Thomas F. O'Shea, MD |
| collection | DOAJ |
| description | Objective: We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements. Methods: A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score. Results: Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) (P = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; P < .001) and sedative infusions (62.1% [n = 36] pre vs 27.6% [n = 16] post; P < .001). The percent of patients on active mechanical ventilation did not differ. Conclusions: The median vasoactive-inotrope score in cardiac surgery patients with prolonged mechanical ventilation was significantly reduced after tracheostomy placement. There was also a significant reduction in the number of patients on vasoactive/inotropic and sedative infusions 3 days after tracheostomy. These data suggest that tracheostomy has a positive effect on the hemodynamic stability of patients after cardiac surgery and should be considered to facilitate postoperative recovery. |
| first_indexed | 2024-04-24T08:12:04Z |
| format | Article |
| id | doaj.art-aebac06174704b5ba7c32365275b4aea |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-24T08:12:04Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-aebac06174704b5ba7c32365275b4aea2024-04-17T04:49:59ZengElsevierJTCVS Open2666-27362024-04-0118138144Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspectiveThomas F. O'Shea, MD0Lynze R. Franko, MD1Dane C. Paneitz, MD, MPH2Kenneth T. Shelton, MD3Asishana A. Osho, MD, MPH4Hugh G. Auchincloss, MD, MPH5Boston University School of Medicine, Boston, MassDepartment of Surgery, Massachusetts General Hospital, Boston, MassBoston University School of Medicine, Boston, Mass; Department of Surgery, Johns Hopkins Hospital, Baltimore, MdDivision of Critical Care, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MassDepartment of Surgery, Massachusetts General Hospital, Boston, Mass; Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MassDepartment of Surgery, Massachusetts General Hospital, Boston, Mass; Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Mass; Address for reprints: Hugh G. Auchincloss, MD, MPH, Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.Objective: We sought to quantify the influence that tracheostomy placement has on the hemodynamic stability of postoperative cardiac surgery patients with persistent ventilatory requirements. Methods: A retrospective, single-center, and observational analysis of postoperative cardiac surgery patients with prolonged mechanical ventilation who underwent tracheostomy placement from 2018 to 2022 was conducted. Patients were excluded if receiving mechanical circulatory support or if they had an unrelated significant complication 3 days surrounding tracheostomy placement. Vasoactive and inotropic requirements were quantified using the Vasoactive-Inotrope Score. Results: Sixty-one patients were identified, of whom 58 met inclusion criteria. The median vasoactive-inotrope score over the 3 days before tracheostomy compared with 3 days after decreased from 3.35 days (interquartile range, 0-8.79) to 0 days (interquartile range, 0-7.79 days) (P = .027). Graphic representation of this trend demonstrates a clear inflection point at the time of tracheostomy. Also, after tracheostomy placement, fewer patients were on vasoactive/inotropic infusions (67.2% [n = 39] pre vs 24.1% [n = 14] post; P < .001) and sedative infusions (62.1% [n = 36] pre vs 27.6% [n = 16] post; P < .001). The percent of patients on active mechanical ventilation did not differ. Conclusions: The median vasoactive-inotrope score in cardiac surgery patients with prolonged mechanical ventilation was significantly reduced after tracheostomy placement. There was also a significant reduction in the number of patients on vasoactive/inotropic and sedative infusions 3 days after tracheostomy. These data suggest that tracheostomy has a positive effect on the hemodynamic stability of patients after cardiac surgery and should be considered to facilitate postoperative recovery.http://www.sciencedirect.com/science/article/pii/S266627362400038Xtracheostomycardiac surgeryhemodynamic stabilityperioperative management |
| spellingShingle | Thomas F. O'Shea, MD Lynze R. Franko, MD Dane C. Paneitz, MD, MPH Kenneth T. Shelton, MD Asishana A. Osho, MD, MPH Hugh G. Auchincloss, MD, MPH Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective JTCVS Open tracheostomy cardiac surgery hemodynamic stability perioperative management |
| title | Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective |
| title_full | Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective |
| title_fullStr | Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective |
| title_full_unstemmed | Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective |
| title_short | Tracheostomy is associated with decreased vasoactive-inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationCentral MessagePerspective |
| title_sort | tracheostomy is associated with decreased vasoactive inotropic score in postoperative cardiac surgery patients on prolonged mechanical ventilationcentral messageperspective |
| topic | tracheostomy cardiac surgery hemodynamic stability perioperative management |
| url | http://www.sciencedirect.com/science/article/pii/S266627362400038X |
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