Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n = 2165; January 2009 - July 2010, n = 2192). The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate logistic regression analysis was performed separately for each cohort.Most recent patients were older, with more co-morbidities, more frequently undergoing off-pump surgery. At the beginning of 2009 we also changed the technique of postoperative ventilation. Percentage of patients with prolonged ventilation decreased from 5.7% to 2.4% (p < 0.0001).Preoperative and procedure-related variables for prolonged ventilation were identified. Prediction models for prolonged ventilation were different for each cohort. Most recent significant predictors were: aortic aneurysm surgery (OR 12.9), emergency surgery (OR 5.3), combined procedures (OR 5.1), valve procedures (OR 3.2), preoperative renal dysfunction (OR 2.9) and preoperative stroke or TIA (OR 2.8).Prediction models for postoperative ventilation should be regularly updated, particularly when major changes are noted in patients' demographics and surgical or anaesthetic technique.Patients whose ventilation after cardiac surgery is unexpectedly prolonged are prone to a larger number of complications and higher mortality [1]. Additionally, they may present a practical problem for the regular activity of the postoperative intensive care unit.In the simplest terms, it can be assumed that up to a certain time limit (usually covering a period of 12-24 hours), the duration of mechanical ventilation may depend on unique characteristics, the type of surgical procedure and local protocols within the individual postoperative ICU. In some ICUs, patients