Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation

J Cardiothorac Vasc Anesth. 2019 Oct;33(10):2709-2716

To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials.

Objective

To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials.

Design

Retrospective analysis.

Setting

Tertiary intensive care unit.

Participants

Cardiac surgery patients.

Interventions

Observational study.

Measurements and Main Results

The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier’s score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier’s score was 0.059, and the model remained well calibrated.

Conclusions

The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.