Risk factors for prolonged mechanical ventilation (PMV) post-coronary bypass surgery
Original Article

Risk factors for prolonged mechanical ventilation (PMV) post-coronary bypass surgery

Stephan Möller ORCID logo, Sophia Cole, Anna Möller, Jan Adriaan Graw

Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany

Contributions: (I) Conception and design: S Möller; (II) Administrative support: A Möller; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: S Möller, S Cole; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Stephan Möller, Dr. med. Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany. Email: stephan.moeller@uniklinik-ulm.de.

Background: Postoperative intensive care plays a crucial role in the perioperative management of coronary artery bypass graft (CABG) surgery. It is well established that patients requiring prolonged mechanical ventilation (PMV) have an increased risk of developing multiple secondary complications such as ventilator-associated pneumonia accounting for the increase of overall morbidity and mortality. The primary focus of our investigation was to identify new risk factors associated with PMV following CABG surgery.

Methods: All patients who underwent isolated coronary artery bypass surgery and were treated in an interdisciplinary surgical intensive care unit (ISICU) of a tertiary University Medical Center in 2023 were included in this retrospective observational study.

Results: A total of 339 patients were included in the study. Among the 280 patients who were successfully extubated within 24 hours after surgery (82.6%), the median ventilation time was 15 hours. In contrast, in the PMV group, the median ventilation time was 48.5 hours. Explorative statistical analysis showed significant differences between the two groups for duration of ventilation, ischemia time, time on cardiopulmonary bypass (CPB), duration of surgery, intensive care unit (ICU) length of stay, hospital length of stay, postoperative drainage loss within 12 and 24 hours after surgery, as well as the European System for Cardiac Operative Risk Evaluation (EuroSCORE). In-hospital mortality was greater in patients with PMV compared to patients without PMV (10.2% vs. 0.0%, P<0.001). Multivariate logistic regression analysis revealed longer time on CPB [odds ratio (OR) =1.01, 95% confidence interval (CI): 1–1.02], a lactate peak within the first 24 hours (OR =1.35, 95% CI: 1.2–1.53), and a higher preoperative EuroSCORE (OR =1.23, 95% CI: 1.05–1.45) as significant independent association for the development of PMV.

Conclusions: Comprehensive understanding of the factors that increase the risk of PMV and a precise characterization of patients prone to PMV are considered essential for the management by the attending intensivist. Early identification of risk factors enables the implementation of targeted interventions, which may optimize intensive care management and ultimately contribute to improved patient outcomes.

Keywords: Mechanical ventilation; cardiac surgery; coronary artery bypass grafting (CABG); risk factors; intensive care management

Submitted Jun 13, 2025. Accepted for publication Oct 29, 2025. Published online Dec 17, 2025.

doi: 10.21037/jtd-2025-1191

Highlight box

Key findings

• In the investigated cohort, prolonged cardiopulmonary bypass duration, an elevated lactate peak within the first 24 hours, and a higher preoperative EuroSCORE were identified as significant independent predictors of prolonged mechanical ventilation (PMV).

What is known and what is new?

• It is well established that patients requiring PMV have an increased risk of developing multiple secondary complications accounting for the increase of overall morbidity and mortality.

• With regard to pre-existing pulmonary conditions such as chronic obstructive pulmonary disease, obstructive sleep apnea syndrome, and nicotine abuse, no significant differences were observed to the disadvantage of patients with PMV.

What is the implication, and what should change now?

• Comprehensive understanding of the factors that increase the risk of PMV and a precise characterization of patients prone to PMV are considered essential for the management by the attending intensivist.

Introduction

In 2022, more than 64,000 patients received coronary artery bypass grafting (CABG) surgery in Germany (1,2). CABG was performed as an isolated procedure in 27,994 (43.6%) of the cases and as a combined procedure in 36,167 (56.4%) of the cases (1,2).

The indication for coronary artery bypass surgery is determined by a so-called “Heart Team”, an interdisciplinary consensus which bases the decision primarily on the complexity of the patient’s coronary disease, functional limitations, symptom burden, and patient preferences. Due to changing patient demographics, an increasing number of elderly coronary heart disease patients are being treated successfully (1,2).

Postoperative intensive care therapy is a cornerstone in the perioperative management of CABG surgery, especially in high-risk surgical patients. While it is possible to wean most patients from mechanical ventilation within 24 hours after cardiac surgery, a fifth of the patients require prolonged mechanical ventilation (PMV) (3-5). According to the Society of Thoracic Surgeons (STS), prolonged ventilation is defined as mechanical ventilation for more than 24 hours after cardiac surgery (6,7).

Early extubation is associated with improved cardiac function, a reduced risk for respiratory complications, an improved patient comfort and reduced overall treatment expenses due to a shorter intensive care unit (ICU) stay (8-16). Necessary prolonged ventilation is not only associated with a risk for multiple postoperative complications such as ventilator-associated pneumonia and an increase in overall morbidity and mortality but also with increased costs of treatment (6,11,17-20).

The objective of the current study was therefore to identify new risk factors associated with PMV following CABG surgery. A better identification and understanding of these risk factors could allow intensivists a more targeted approach when adjusting intensive care treatment strategies which might positively impact patient outcomes. We present this article in accordance with the STROBE reporting checklist (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1191/rc).

Methods

This retrospective observational study includes all patients who underwent isolated coronary artery bypass surgery and were treated in the interdisciplinary surgical intensive care unit (ISICU) of the University Medical Center Ulm in 2023. CABG patients requiring revision surgery were excluded from the analysis. PMV was defined as the need for ventilation for more than 24 hours according to the recommendation of the STS (6,7,21). Starting time point of mechanical ventilation was the endotracheal intubation during induction of anesthesia and end point of mechanical ventilation was postoperative extubation in the ISICU. In accordance with our institutional protocol, extubation is only performed once the following criteria are met: hemodynamic stability, absence of excessive drainage losses (less than 100 mL/h), full consciousness, the ability to move both upper and lower extremities on command, and no evidence of neurological deficits. Furthermore, readiness for extubation requires a stable metabolic status, adequate spontaneous respiration, and a arterial partial pressure of oxygen (PaO2) exceeding 70 mmHg. Chest X-ray must rule out significant pathologies, including pneumothorax, pleural effusions, atelectasis, or extensive emphysema. Ultimately, the responsibility for the clinical decision to proceed with extubation lies with the attending intensive care physician at the bedside.

The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the University of Ulm (No. 398/24). Informed consent was waived in this retrospective study.

All data required for this study were extracted from the electronic patient data management system (SAP, Walldorf, Germany). Laboratory parameters were collected at the beginning of ICU treatment unless noted otherwise.

Statistical analysis

Data processing was completed using Excel 2019 (Microsoft, Redmond, USA), statistical analysis was conducted using DATAtab [DATAtab Team (2025), DATAtab e. U. Graz, Austria]. Results are expressed as median [first quartile (Q1), third quartile (Q3)]. Differences in metric variables were tested using the non-parametric Mann-Whitney U test. The Chi-squared test was used for categorical variables. Risk factors for PMV were determined using multivariate logistic regression analysis. A post-hoc evaluation was performed for parameters identified as significant predictors of increased likelihood of developing PMV to reassess the potential significant relationship among these parameters. The Spearman correlation coefficient was applied for this analysis.

All tests were conducted in the area of exploratory data analysis. A two-tailed P<0.05 was considered statistically significant.

Results

A total of 339 patients who underwent isolated coronary artery bypass surgery and were subsequently treated in the ISICU were included in the study. The patients’ ages ranged from 36 to 85 years old and 82.1% (n=278) of the patients were male.

Within our study population, hyperlipoproteinemia (85.4%), arterial hypertension (81.6%), diabetes mellitus (36.6%), active nicotine abuse (36.0%), and peripheral arterial disease (12.0%) represented the most frequent pre-existing comorbidities. Regarding pulmonary comorbidities, the most common conditions observed were obstructive sleep apnea syndrome (OSAS) (7.6%), chronic obstructive pulmonary disease (COPD) (7.3%), and bronchial asthma (1.5%).

Median ventilation time among all patients was 16 hours (Q1, Q3, 12, 22 hours) while 17.4% (n=59) of the patients required PMV (Table 1). Among the 280 patients who were successfully extubated within 24 hours after surgery (82.6%), the median ventilation time was 15 hours. Meanwhile, in the PMV group, the median ventilation time was 48.5 hours.

Table 1

Comparison of metric preoperative, intraoperative, and postoperative variables between the PMV and the non-PMV groups

Variables PMV group (n=59) Non-PMV group (n=280) P value (Mann-Whitney U test)
Age (years) 69 [60, 74] 66 [60, 73] 0.30
Body mass index (kg/m2) 27 [24, 30.25] 27.5 [25, 31] 0.51
Duration of mechanical ventilation (hours) 48.5 [29.25, 130.5] 15 [11, 18] <0.001
PaO2/FiO2 ratio (mmHg) 268 [187.25, 333.5] 280 [222.5, 350] 0.31
Ischemia time (minutes) 75 [57, 108] 57 [45, 72] <0.001
Cardiopulmonary bypass time (minutes) 145 [119, 192.5] 103 [84, 125.25] <0.001
Surgical duration (minutes) 287 [231, 357.5] 227 [196.75, 261.25] <0.001
ICU length of stay (days) 9 [6, 13.5] 4 [3, 5] <0.001
Hospital length of stay (days) 15 [11, 18] 11 [9, 13] <0.001
Drain output within the first 12 hours (mL) 785 [390, 1,245] 420 [310, 600] <0.001
Drain output within the first 24 hours (mL) 1,037.5 [600, 1,805] 700 [520, 930] <0.001
24-hour fluid balance (mL) 2,837.5 [2,327.5, 3,795] 2,780 [1,950, 3,390] 0.12
EuroSCORE (%) 4.33 [1.95, 10.76] 1.27 [0.85, 2.17] <0.001

Data are presented as median [first quartile, third quartile]. EuroSCORE, European System for Cardiac Operative Risk Evaluation; FiO2, fraction of inspired oxygen; ICU, intensive care unit; mL, milliliter; mmHg, millimeters of mercury; PaO2, arterial partial pressure of oxygen; PMV, prolonged mechanical ventilation.

Explorative statistical analysis showed significant differences between the two groups for duration of ventilation, ischemia time, time on cardiopulmonary bypass (CPB), duration of surgery, ICU length of stay, hospital length of stay, postoperative drainage loss within 12 and 24 hours after surgery, as well as the European System for Cardiac Operative Risk Evaluation (EuroSCORE) (Table 1). Laboratory parameters collected at the beginning of ICU therapy are demonstrated in Table 2. With the exception of hematocrit and platelet count, all parameters demonstrated significant differences in this analysis.

Table 2

Comparison of laboratory findings at ICU admission using the Mann-Whitney U test

Variables PMV group (n=59) Non-PMV group (n=280) P value (Mann-Whitney U test)
Platelet count (×109//L) 153 [127, 186.5] 147.5 [120, 172] 0.19
Activated partial thromboplastin time (s) 41 [35, 65.5] 34 [31, 38.25] <0.001
International normalized ratio 1.3 [1.2, 1.4] 1.2 [1.1, 1.2] <0.001
Activated clotting time (s) 155 [144.5, 170] 145 [137, 154] <0.001
Serum creatinine level (μmol/L) 95 [79, 125.5] 80.5 [68, 93] <0.001
Glomerular filtration rate (mL/min) 63 [48.5, 86] 84 [72, 93] <0.001
Hematocrit 0.29 [0.27, 0.31] 0.29 [0.28, 0.32] 0.18
Creatine kinase-MB (μg/L) 29.3 [16.8, 52.5] 14.5 [10.6, 21.73] <0.001
Troponin T (ng/L) 1,082 [510, 1,638.5] 353 [209.5, 596.5] <0.001
Lactate (mmol/L) 2.4 [1.4, 4.97] 1.2 [1, 1.5] <0.001
Lactate peak within 24 hours (mmol/L) 6.6 [3, 10.9] 2.25 [1.7, 3.4] <0.001

Data are presented as median [first quartile, third quartile]. ICU, intensive care unit; L, liter; min, minutes; mL, milliliter; PMV, prolonged mechanical ventilation; s, seconds.

In-hospital mortality was greater in patients with PMV compared to patients without PMV (PMV: 10.2%, n=59 vs. non-PMV: 0.0%, n=280, P<0.001, Table 3). Likewise, increased blood loss within 24 hours after surgery, the incidence of bleeding related revision surgery, and the incidence of atrial fibrillation as preoperative comorbidity were higher in patients with PMV compared to patients without PMV (Table 3).

Table 3

Comparison of categorial variables between the PMV and non-PMV groups using the Chi-squared test

Variables PMV group (n=59) Non-PMV group (n=280) χ2 test P value
In-hospital mortality 6 0 28.99 <0.001
Male 49 229 0.05 0.81
Requirement for reintubation 3 5 2.3 0.12
Drain output >1,000 mL/24 hours 29 61 19.11 <0.001
Bleeding-related reoperation 5 1 18.47 <0.001
Type 2 diabetes 14 110 5.08 0.02
Current smoker 18 104 0.93 0.33
Arterial hypertension 46 232 0.79 0.37
Chronic obstructive pulmonary disease 2 23 1.66 0.19
Bronchial asthma 1 4 0.02 0.87
Chronic kidney disease 11 20 7.76 0.005
Atrial fibrillation 16 21 19.29 <0.001
History of stroke 8 22 1.96 0.16
History of psychiatric disorders 3 6 1.63 0.20
Hypothyroidism 6 34 0.18 0.66
Alcohol use disorder 3 17 0.09 0.77
Obstructive sleep apnea syndrome 4 22 0.08 0.77

mL, milliliter; PMV, prolonged mechanical ventilation.

Multivariate logistic regression analysis revealed longer CPB time (OR =1.01, 95% CI: 1–1.02), a lactate peak within the first 24 hours (OR =1.35, 95% CI: 1.2–1.53), and a higher preoperative EuroSCORE (OR =1.23, 95% CI: 1.05–1.45) as significant independent association for the development of PMV. A merely moderate positive relationship was identified across all three parameters (Spearman correlation between CPB time and peak lactate; r=0.33; P<0,001; Spearman correlation between CPB time and EuroSCORE; r=0.34; P<0.001; Spearman correlation peak lactate and EuroSCORE; r=0.35; P<0.001). The other examined variables showed no significant association (Table 4). Preoperative smoking status or pre-existing pulmonary conditions such as OSAS or COPD could not be identified as risk factors for prolonged ventilation (Table 4).

Table 4

Regression analysis of potential risk factors for prolonged mechanical ventilation exceeding 24 hours

Variables B P value Odds ratio 95% confidence interval
Age (years) 0.01 0.58 1.01 0.96–1.07
Body mass index (kg/m2) −0.03 0.54 0.97 0.89–1.06
Cardiopulmonary bypass time (min) 0.01 0.003 1.01 1–1.02
Peak lactate level within the first 24 hours (mmol/L) 0.3 <0.001 1.35 1.2–1.53
Drain output within the first 12 hours (mL) 0 0.10 1 1–1
Current smoker −0.33 0.48 0.72 0.28–1.82
Chronic obstructive pulmonary disease 1.55 0.11 4.71 0.68–32.74
Obstructive sleep apnea syndrome 0.77 0.32 2.16 0.47–10.02
EuroSCORE (%) 0.21 0.01 1.23 1.05–1.45

EuroSCORE, European System for Cardiac Operative Risk Evaluation; min, minutes.

Discussion

Despite increasing availability of evidence, the clinical and financial implications of PMV following cardiac surgery remain a subject of current discussion. In our study, significant differences between the PMV and non-PMV groups were primarily observed with respect to ischemia time, time on CPB, postoperative drainage loss and laboratory parameters like the serum lactate plasma concentration at ICU admission and the peak serum lactate plasma concentration within the first 24 hours after ICU admission.

It is well established that cardiac surgery involving CPB triggers inflammatory processes that can lead to multiple organ dysfunctions (8,22). In addition to systemic inflammation, pulmonary damage is of particular interest in the perioperative period. Postoperative pulmonary impairment ranges from subclinical changes to increased permeability of the pulmonary capillaries, resulting in functional pulmonary compromise and even respiratory failure (23-25).

Several studies have already identified time on CPB as an independent risk factor for PMV in patients with CABG (6,26). This study confirmed that longer time on CPB, consecutively longer ischemia time, and longer duration of the entire surgical procedure were associated with PMV. Perfusion time emerged as an independent association for the development of PMV. An extended CBP period initiates a cascade of downstream events. These are characterized by an enhanced proinflammatory response and the release of various inflammatory cytokines. These processes promote an increased susceptibility to ischemia-reperfusion injury and hemolysis. This enhances the vulnerability to pulmonary complications, potentially leading to prolonged ventilatory support (27,28). Owing to multifactorial determinants, managing CPB duration poses a considerable challenge for the multidisciplinary team. Awareness that extended CPB time contributes to a higher likelihood of prolonged postoperative ventilation should inform operative decision-making and strategy.

In contrast to previous studies, we did not detect any differences between the PMV group and the non-PMV group concerning preexisting COPD, OSAS, or smoking status (29-34). Only the study by Cislaghi et al. was consistent with our findings. In general, these pulmonary comorbidities tend to be associated with more severe forms of respiratory dysfunction rather than mild or moderate ones (8,31). In our institution, specific treatment protocols are implemented by cardioanesthesiologists for patients with bronchial asthma or COPD throughout the entire course of hospitalization, beginning with the first patient contact. It is possible that this successful management strategy accounted for the results reported in this study. Interestingly, no differences were observed in the oxygenation index [Horowitz index = PaO2/fraction of inspired oxygen (FiO2)] between the PMV and non-PMV groups on ICU admission. It is unclear whether a low Horowitz index correlates with an increased likelihood for PMV. To date, there are no comparative studies, because the Horowitz index was not routinely collected in other investigations. Only Ji et al. reported a low preoperative PaO2 level as an independent risk factor for PMV (35). However, the authors did not assess a postoperative oxygenation index either.

Lactate is produced as the final product of anaerobic glycolysis and is primarily used in clinical practice as a marker of cellular hypoxia (36-38). Lactic acidosis often reflects the severity of a patient’s medical condition. Several studies have shown that monitoring dynamic changes in serum lactate concentrations can help to identify critically ill patients with an increased risk of mortality (36-39). Aksoy and colleagues identified perioperative serum lactate levels as a significant predictor of PMV (26). In the study conducted by Hakim and colleagues, a significant correlation was observed between arterial lactate concentrations as well as lactate clearance and the duration of mechanical ventilation (40). Another study demonstrated an association between a lactate level ≥4 mmol/L on ICU admission and PMV following cardiac surgery involving CPB (41). Furthermore, an isolated elevated lactate level ≥4 mmol/L was also found an independent risk factor for major postoperative complications (41). In the current study, the serum lactate level at ICU admission was significantly higher in the PMV group compared to the non-PMV group. In addition, our data revealed a significant difference between the two groups regarding the lactate peak within the first 24 postoperative hours. In the regression analysis, this lactate peak proved to show an independent association for the development of PMV. These findings suggest that lactate is a valuable laboratory parameter for perioperative risk assessment in patients after CABG surgery.

Excessive postoperative bleeding following cardiac surgery is a dreaded complication and has been proven to have detrimental impact on patient outcomes (42). The incidence of surgical reinterventions due to bleeding is reported to be as high as 5.3% (42). In our cohort, the overall rate of surgical reintervention due to bleeding was only 1.8%. However, the PMV group had a significantly higher rate of bleeding-related reinterventions compared to the non-PMV group. Aksoy and colleagues also reported a significant association between bleeding-related reintervention and PMV (26). Nevertheless, regression analysis did not identify drainage loss within the first 12 hours as an independent factor associated with PMV. Regardless, patients exhibiting increased drainage losses appear to remain intubated and mechanically ventilated for a prolonged duration as a precautionary measure. Hourly drainage loss often serves as a key criterion in institutional weaning protocols. In this context, a potential circular relationship may develop, potentially diminishing the causal impact of postoperative drainage losses on ventilation time. Accordingly, both, surgical interventions and intensive care measures designed to minimize postoperative blood loss are likely to contribute to a reduced duration of mechanical ventilation.

Reflecting the severity of illness, the preoperatively determined EuroSCORE was significantly higher in the PMV group compared to the non-PMV group. Furthermore, regression analysis revealed a significant correlation between the preoperative EuroSCORE and the postoperative development of PMV. In previous investigations, PMV was associated with greater disease severity, as measured by the EuroSCORE (20). It is therefore not surprising that patients with higher EuroSCORE values have an increased risk of developing PMV. However, this knowledge can be utilized to improve resource allocation for the care of this patient population. In addition, a more detailed preoperative informed consent process could be conducted for these patients.

In contrast to the findings reported by Aksoy and colleagues, our patient cohort demonstrated a significantly higher in-hospital mortality rate in the PMV group compared to the non-PMV group (26). An elevated mortality rate among patients undergoing PMV has likewise been corroborated by findings from previous investigations like Fernandez-Zamora and colleagues (20). However, it remains unclear in the present study whether PMV itself contributes causally to the increased mortality, or whether it merely reflects a patient population with greater baseline illness severity. It is, however, plausible that early measures to prevent PMV could ultimately contribute to a reduction in mortality.

Primary limitations of this study arise from the retrospective, single-center study design. In this context, the potential for selection bias and unmeasured confounding cannot be fully ruled out. Several important parameters were not recorded and could not be analyzed. For instance, the database we used does not contain information on catecholamine requirements or echocardiographic findings, which could serve as surrogate markers for cardiovascular dysfunction. Additionally, ventilator parameters, such as tidal volumes or positive end-expiratory pressure (PEEP), were not included in the data collection. Due to the single-center design of this data collection, the results may not be generalizable to other institutions.

Conclusions

Comprehensive understanding of the factors that increase the risk of PMV and a precise characterization of patients prone to PMV are considered essential for the management by the attending intensivist. One of the main objectives is, within the framework of risk stratification, to assess the severity of illness of the patient being managed. Furthermore, prompt recognition of risk factors allows for the immediate initiation of interventions aimed at optimizing intensive care treatment and improving patient outcomes. Further investigations are necessary to improve identification of patients at risk. Future research should consider to develop reliable predictive models based on pre-, intra-, and postoperative variables that allow valid risk assessment upon ICU admission regarding the likelihood of developing PMV.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1191/rc

Data Sharing Statement: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1191/dss

Peer Review File: Available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1191/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2025-1191/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Ethics Committee of the University of Ulm (No. 398/24). Informed consent was waived in this retrospective study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. Ensminger S, Thiele H, Falk V, et al. Der Deutsche Herzbericht – Update 2024 – Eine Zusammenfassung der wichtigsten Erkenntnisse. Kardiologie 2024;18:476-84.
  2. Deutsche Gesellschaft für Kardiologie. Der Deutsche Herzbericht – Update 2024. [cited 2025 Feb 22]. Available online: https://herzstiftung.de/
  3. Rahimi S, Abdi A, Salari N, et al. Factors associated with long-term mechanical ventilation in patients undergoing cardiovascular surgery. BMC Cardiovasc Disord 2023;23:276. [Crossref] [PubMed]
  4. Gumus F, Polat A, Yektas A, et al. Prolonged mechanical ventilation after CABG: risk factor analysis. J Cardiothorac Vasc Anesth 2015;29:52-8. [Crossref] [PubMed]
  5. Imanipour M, Bassampour S, Bahrani N. Preoperative variables associated with extubation time in patients undergoing coronary artery bypass graft surgery. Journal of Hayat 2006;12:5-16. [Crossref] [PubMed]
  6. Yang H, Kong L, Lan W, et al. Risk factors and clinical prediction models for prolonged mechanical ventilation after heart valve surgery. BMC Cardiovasc Disord 2024;24:250. [Crossref] [PubMed]
  7. Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med 2020;46:888-906. [Crossref] [PubMed]
  8. Cislaghi F, Condemi AM, Corona A. Predictors of prolonged mechanical ventilation in a cohort of 3,269 CABG patients. Minerva Anestesiol 2007;73:615-21.
  9. Gopalan PD, Burrows RC. Critical care of the vascular surgery patient. Crit Care Clin 2003;19:109-25. [Crossref] [PubMed]
  10. Branca P, McGaw P, Light R. Factors associated with prolonged mechanical ventilation following coronary artery bypass surgery. Chest 2001;119:537-46. [Crossref] [PubMed]
  11. Engoren M, Buderer NF, Zacharias A. Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery. Crit Care Med 2000;28:2742-9. [Crossref] [PubMed]
  12. Habib RH, Zacharias A, Engoren M. Determinants of prolonged mechanical ventilation after coronary artery bypass grafting. Ann Thorac Surg 1996;62:1164-71. [Crossref] [PubMed]
  13. LoCicero J 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med 1992;20:990-2. [Crossref] [PubMed]
  14. Peters RM, Brimm JE, Utley JR. Predicting the need for prolonged ventilatory support in adult cardiac patients. J Thorac Cardiovasc Surg 1979;77:175-82.
  15. Ko HK, Liu CY, Ho LI, et al. Predictors of delayed extubation following lung resection: Focusing on preoperative pulmonary function and incentive spirometry. J Chin Med Assoc 2021;84:368-74. [Crossref] [PubMed]
  16. Zilberberg MD, de Wit M, Shorr AF. Accuracy of previous estimates for adult prolonged acute mechanical ventilation volume in 2020: update using 2000-2008 data. Crit Care Med 2012;40:18-20. [Crossref] [PubMed]
  17. Demling RH, Read T, Lind LJ, et al. Incidence and morbidity of extubation failure in surgical intensive care patients. Crit Care Med 1988;16:573-7. [Crossref] [PubMed]
  18. Trudzinski FC, Neetz B, Bornitz F, et al. Risk Factors for Prolonged Mechanical Ventilation and Weaning Failure: A Systematic Review. Respiration 2022;101:959-69. [Crossref] [PubMed]
  19. Béduneau G, Pham T, Schortgen F, et al. Epidemiology of Weaning Outcome according to a New Definition. The WIND Study. Am J Respir Crit Care Med 2017;195:772-83. [Crossref] [PubMed]
  20. Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery. Respir Care 2018;63:550-7. [Crossref] [PubMed]
  21. LaPar DJ, Gillen JR, Crosby IK, et al. Predictors of operative mortality in cardiac surgical patients with prolonged intensive care unit duration. J Am Coll Surg 2013;216:1116-23. [Crossref] [PubMed]
  22. Weiland AP, Walker WE. Physiologic principles and clinical sequelae of cardiopulmonary bypass. Heart Lung 1986;15:34-9.
  23. Apostolakis E, Filos KS, Koletsis E, et al. Lung dysfunction following cardiopulmonary bypass. J Card Surg 2010;25:47-55. [Crossref] [PubMed]
  24. Raja SG, Dreyfus GD. Modulation of systemic inflammatory response after cardiac surgery. Asian Cardiovasc Thorac Ann 2005;13:382-95. [Crossref] [PubMed]
  25. Rothenburger M, Soeparwata R, Deng MC, et al. Prediction of clinical outcome after cardiac surgery: the role of cytokines, endotoxin, and anti-endotoxin core antibodies. Shock 2001;16:44-50. [Crossref] [PubMed]
  26. Aksoy R, Karakoc AZ, Cevirme D, et al. Predictive Factors of Prolonged Ventilation Following Cardiac Surgery with Cardiopulmonary Bypass. Braz J Cardiovasc Surg 2021;36:780-7. [Crossref] [PubMed]
  27. Sharma V, Rao V, Manlhiot C, et al. A derived and validated score to predict prolonged mechanical ventilation in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg 2017;153:108-15. [Crossref] [PubMed]
  28. Wang Q, Tao Y, Zhang X, et al. The Incidence, Risk Factors, and Hospital Mortality of Prolonged Mechanical Ventilation among Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Rev Cardiovasc Med 2024;25:409. [Crossref] [PubMed]
  29. Daza-Arana JE, Lozada-Ramos H, Ávila-Hernández DF, et al. Prolonged Mechanical Ventilation Following Coronary Artery Bypass Graft in Santiago De Cali, Colombia. Vasc Health Risk Manag 2022;18:767-81. [Crossref] [PubMed]
  30. Piotto RF, Ferreira FB, Colósimo FC, et al. Independent predictors of prolonged mechanical ventilation after coronary artery bypass surgery. Rev Bras Cir Cardiovasc 2012;27:520-8. [Crossref] [PubMed]
  31. Rajakaruna C, Rogers CA, Angelini GD, et al. Risk factors for and economic implications of prolonged ventilation after cardiac surgery. J Thorac Cardiovasc Surg 2005;130:1270-7. [Crossref] [PubMed]
  32. Pappalardo F, Franco A, Landoni G, et al. Long-term outcome and quality of life of patients requiring prolonged mechanical ventilation after cardiac surgery. Eur J Cardiothorac Surg 2004;25:548-52. [Crossref] [PubMed]
  33. LoCicero J 3rd, McCann B, Massad M, et al. Prolonged ventilatory support after open-heart surgery. Crit Care Med 1992;20:990-2. [Crossref] [PubMed]
  34. Miyamoto T, Kimura T, Hadama T. The benefits and new predictors of early extubation following coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 2000;6:39-45.
  35. Ji Q, Duan Q, Wang X, et al. Risk factors for ventilator dependency following coronary artery bypass grafting. Int J Med Sci 2012;9:306-10. [Crossref] [PubMed]
  36. Kramer A, Urban N, Döll S, et al. Early Lactate Dynamics in Critically Ill Non-Traumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE-Lactate-Study). J Emerg Med 2019;56:135-44. [Crossref] [PubMed]
  37. Kramer A, Al Agha S, Böhm L, et al. Lactate in emergency medicine. Anaesthesist 2020;69:826-34. [Crossref] [PubMed]
  38. Stephens EH, Epting CL, Backer CL, et al. Hyperlactatemia: An Update on Postoperative Lactate. World J Pediatr Congenit Heart Surg 2020;11:316-24. [Crossref] [PubMed]
  39. Chebl RB, Tamim H, Dagher GA, et al. Serum Lactate as an Independent Predictor of In-Hospital Mortality in Intensive Care Patients. J Intensive Care Med 2020;35:1257-64. [Crossref] [PubMed]
  40. Hakim MZ, Tewarson V, Kumar S, et al. Early Mortality in Cardiac Surgery - Is Lactate Significant? Braz J Cardiovasc Surg 2024;e20230245:e20230245.
  41. Laine GA, Hu BY, Wang S, et al. Isolated high lactate or low central venous oxygen saturation after cardiac surgery and association with outcome. J Cardiothorac Vasc Anesth 2013;27:1271-6. [Crossref] [PubMed]
  42. Biancari F, Mikkola R, Heikkinen J, et al. Individual Surgeon’s Impact on the Risk of Re-exploration for Excessive Bleeding After Coronary Artery Bypass Surgery. Journal of Cardiothoracic and Vascular Anesthesia 2012;26:550-6. [Crossref] [PubMed]
Cite this article as: Möller S, Cole S, Möller A, Graw JA. Risk factors for prolonged mechanical ventilation (PMV) post-coronary bypass surgery. J Thorac Dis 2025;17(12):10935-10943. doi: 10.21037/jtd-2025-1191

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