Prolonged ventilatory support after open-heart surgery

OBJECTIVESTo characterize the course of open-heart surgery patients who require prolonged (>72 hrs) mechanical ventilation and to define the role and timing of tracheostomy. DESIGNRetrospective review. SETTINGCardiac surgery ICU and surgery wards at a university hospital. PATIENTSAll open-heart surgery patients during an 18-month period from January 1988 to July 1989 (n = 581). From this group, 58 patients (9.9%) required prolonged mechanical ventilation. INTERVENTIONSStudy patients (n = 58) were followed through the course of intubation and/or tracheostomy until they were extubated, left the hospital on ventilation, or died. MEASUREMENTS AND MAIN RESULTSEnd-points for mortality and complications were determined. Overall mortality rate was 43% in the patients who required prolonged mechanical ventilation. Twenty-eight percent of the 58 patients died within the first 14 days. Of those patients who survived, 55% required an endotracheal tube only and were extubated in