Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

Jacek B. Cywinski, Meng Xu, Daniel I. Sessler, David Mason, Colleen Koch

Research output: Contribution to journalArticle

Abstract

Objective: The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. Design: An observational cohort investigation. Setting: A tertiary referral center. Participants: The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Interventions: Not applicable. Measurements and Main Results: Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV1 were associated with an increased risk of delayed extubation after lung resection. Conclusion: Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV1, and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.

Original languageEnglish (US)
Pages (from-to)766-769
Number of pages4
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume23
Issue number6
DOIs
StatePublished - Dec 2009
Externally publishedYes

Fingerprint

Intratracheal Intubation
Thoracotomy
Erythrocyte Transfusion
Lung
Epidural Analgesia
Creatinine
Thorax
Airway Extubation
Anesthesia and Analgesia
Perioperative Period
Pneumonectomy
Epidural Anesthesia
Serum
Artificial Respiration
Tertiary Care Centers
Lung Diseases
Patient Care
Catheters
Logistic Models
Population

Keywords

  • anesthesia
  • extubation
  • lung resection
  • postoperative mechanical ventilation
  • thoracotomy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection. / Cywinski, Jacek B.; Xu, Meng; Sessler, Daniel I.; Mason, David; Koch, Colleen.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 23, No. 6, 12.2009, p. 766-769.

Research output: Contribution to journalArticle

@article{454c71bbabb04d139cd2e3acdc8388c4,
title = "Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection",
abstract = "Objective: The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. Design: An observational cohort investigation. Setting: A tertiary referral center. Participants: The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Interventions: Not applicable. Measurements and Main Results: Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV1 were associated with an increased risk of delayed extubation after lung resection. Conclusion: Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV1, and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.",
keywords = "anesthesia, extubation, lung resection, postoperative mechanical ventilation, thoracotomy",
author = "Cywinski, {Jacek B.} and Meng Xu and Sessler, {Daniel I.} and David Mason and Colleen Koch",
year = "2009",
month = "12",
doi = "10.1053/j.jvca.2009.03.022",
language = "English (US)",
volume = "23",
pages = "766--769",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "6",

}

TY - JOUR

T1 - Predictors of Prolonged Postoperative Endotracheal Intubation in Patients Undergoing Thoracotomy for Lung Resection

AU - Cywinski, Jacek B.

AU - Xu, Meng

AU - Sessler, Daniel I.

AU - Mason, David

AU - Koch, Colleen

PY - 2009/12

Y1 - 2009/12

N2 - Objective: The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. Design: An observational cohort investigation. Setting: A tertiary referral center. Participants: The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Interventions: Not applicable. Measurements and Main Results: Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV1 were associated with an increased risk of delayed extubation after lung resection. Conclusion: Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV1, and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.

AB - Objective: The aim of this study was to identify predictors of delayed endotracheal extubation defined as the need for postoperative ventilatory support after open thoracotomy for lung resection. Design: An observational cohort investigation. Setting: A tertiary referral center. Participants: The study population consisted of 2,068 patients who had open thoracotomy for pneumonectomy, lobectomy, or segmental lung resection between January 1996 and December 2005. Interventions: Not applicable. Measurements and Main Results: Preoperative and intraoperative variables were collected concurrently with the patient's care. Risk factors were identified using logistic regression with stepwise variable selection procedure on 1,000 bootstrap resamples, and a bagging algorithm was used to summarize the results. Intraoperative red blood cell transfusion, higher preoperative serum creatinine level, absence of a thoracic epidural catheter, more extensive surgical resection, and lower preoperative FEV1 were associated with an increased risk of delayed extubation after lung resection. Conclusion: Most predictors of delayed postoperative extubation (ie, red blood cell transfusion, higher preoperative serum creatinine, lower preoperative FEV1, and more extensive lung resection) are difficult to modify in the perioperative period and probably represent greater severity of underlying lung disease and more advanced comorbid conditions. However, thoracic epidural anesthesia and analgesia is a modifiable factor that was associated with reduced odds for postoperative ventilatory support. Thus, the use of epidural analgesia may reduce the need for post-thoracotomy mechanical ventilation.

KW - anesthesia

KW - extubation

KW - lung resection

KW - postoperative mechanical ventilation

KW - thoracotomy

UR - http://www.scopus.com/inward/record.url?scp=70450224893&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=70450224893&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2009.03.022

DO - 10.1053/j.jvca.2009.03.022

M3 - Article

C2 - 19525128

AN - SCOPUS:70450224893

VL - 23

SP - 766

EP - 769

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 6

ER -