Predictors of weaning failure from mechanical ventilation in post-cardiac surgery patients

Abstract

Objectives: This research endeavors to pinpoint the variables that foretell failure to wean from mechanical ventilation (MV) among individuals who have experienced cardiac surgery, aiming to mitigate the hazards linked to prolonged stays in the intensive care unit (ICU).

Methodology: The investigation was conducted in the ICU for post-cardiac surgery patients at Ain Shams University Hospital. The study included 80 patients who had undergone cardiac surgery and were subsequently on MV.

Results: Successful extubation was achieved in most patients enrolled in the study. Intraoperative complications were common among participants, with pacemaker wire insertion being the most frequent, followed by ventricular fibrillation. The most frequently performed surgical procedure was coronary artery bypass grafting (CABG), with mitral valve replacement (MVR) being the second most common. Most patients exhibited mild to moderate tracheal secretions. Significant differences were observed between successfully weaned patients and those who failed extubation. Specifically, the failed extubation group demonstrated significantly higher Charlson Comorbidity Index scores, a greater prevalence of chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVS), and significantly lower mean blood pressure (MBP) and PaO₂/FiO₂ ratios.

Conclusion: The study's results indicate that several independent factors are linked to a higher probability of unsuccessful weaning from MV. These factors include a Sequential Organ Failure Assessment (SOFA) score of 6 or above, a Comorbidity Index exceeding 3, severe tracheal secretions, a respiratory rate to tidal volume ratio (RR/TV) of 57 or higher, and minute ventilation of 13.5 L/min or more.

Abbreviations: ACC: aortic cross-clamp, CABG: coronary artery bypass grafting, COPD: chronic obstructive pulmonary disease, ECC: extracorporeal circulation, MV: mechanical ventilation, MVR: mitral valve replacement

Keywords: Cardiac Surgery; Mechanical Ventilation; Weaning Failure

Citation: Mohamed Ali MAK, Mohamed NMK, Elgendy HM, Mohamed AlAwady DES, Sayed HM. Predictors of weaning failure from mechanical ventilation in post-cardiac surgery patients. Anaesth. pain intensive care 2025;29(2):278-283. DOI: 10.35975/apic.v29i2.2716

Received: February 04, 2025; Revised: February 13, 2025; Accepted: February 15, 2025