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Retrospective study of ventilation after major aortic surgery

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(1)

Results

Introduction about

ventilation

Jean-Noël KOCH, ECCP

University hospital of Liege

(2)

Data base

Operative and postoperative data from

(3)

Multivariate analysis

Age, gender, BSA,

Emergency, redo, COPD

Thoracoabdominal aortic surgery

Deep hypothermia circulatory arrest,

Nadir haematocrit

Priming volume

Platelets, Fresh Frozen Plasma, Red Blood Cells

transfusion

Cell saving

(4)

Univariate analysis

Significate association

Higher cross clamp time

Use of dobutamine and noradrenaline

No association

Age

Surgery on thoracoabdominal aorta

COPD

(5)

Univariate analysis

Trend

Higher pump time

Lower nadir ACT

Greater cell-saving

Higher proportion of redo

Higher proportion of transfusion

Association with CRRT

Lower first ICU PaO2/FiO2

(6)

Univariate analysis

Respiratory complication

No Yes p

Median P25-P75 Median P25-P75

1st ICU PaO2/FiO2 286 220-382 232 183-307 0,07 Ventilation time (h) 9 6-16,5 17 9-23 0,05 Pump time (') 117 90-150 135 110-198 0,07 Cross clamp time

(') 80 59-102 99 71-130 0,04** Nadir ACT (sec) 405 387-429 386 371-430 0,07 Cell saving (ml) 940 700-1250 1165,5 766-1600 0,08 Redo 17 (7,02%) 3 (20,0%) 0,10 Dobutamine 82 (36,1%) 10 (66,7%) 0,02** Noradrenaline 68 (29,6%) 9 (60,0%) 0,02** CRRT 15 (6,79%) 3 (20,0%) 0,09 RBC 109 (45,0%) 10 (66,7%) 0,09 FFP 123 (50,8%) 11 (73,3%) 0,08 PLT 107 (44,2%) 10 (66,7%) 0,08

(7)
(8)

Respiratory complications

No

Yes

p-Value

median P25-P75 Median P25-P75

Ventilation time (h) 8 6-13 10 7-23 0,17

PaO2/FiO2 285 212-382 263 183-352 0,03

Colloid versus Crystalloid Priming/ perfusion

HES

(n=257)

Plasmalyte A (n=53)

p-Value

median P25-P75 Median P25-P75 Ventilation time (h) 9 6-17 6 5-8 <0,0001 PaO2/FiO2 281 216-374 298 183-384 0,319 Respiratory complications 15 (5,84%) 9 (17,0%) 0,006

(9)
(10)

Mechanical ventilation duration

(11)
(12)

Length of ICU hospitalization depending on priming solutions and respiratory complication Alive Dead p<0,00001 Crystalloid without complication Crystaloid with complication Colloid without complication Colloid with 0 10 20 30 40 50 60 70 80 90 100 110 -0,2 0,0 0,2 0,4 0,6 0,8 1,0 Prop ortion of hos pitalize d pa tients in ICU

ICU stay

(13)
(14)

Conclusions

Take care of patients :

Longer cross clamp time

Need of cathecolamines

Lower first ICU PaO

2

/FiO

2

Use crystalloid priming

Reduce mechanical ventilation time

Reduce length of stay in ICU and in the hospital

Could lead to more respiratory complications (without

(15)

THANKS FOR YOUR

ATTENTION

Références

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