Clinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest

Augoustides, John G.; Pochettino, Alberto; Ochroch, E. Andrew; Cowie, Doreen; McGarvey, Michael L.; Weiner, Justin; Gambone, Andrew J.; Pinchasik, Dawn; Cheung, Albert T.; Bavaria, Joseph E.

doi:10.1053/j.jvca.2005.07.031

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 1 , Pages 8-13, February 2006

Clinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest

John G. Augoustides, MD
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Address reprint requests to John G. Augoustides, MD, Department of Anesthesia, 680 Dulles, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283
Alberto Pochettino, MD
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
E. Andrew Ochroch, MD
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Doreen Cowie, CCP
- Department of Clinical Perfusion, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Michael L. McGarvey, MD
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
Justin Weiner, BA
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Andrew J. Gambone, BA
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Dawn Pinchasik, BA
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Albert T. Cheung, MD
- Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
Joseph E. Bavaria, MD
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Objective: The purpose of this study was to describe clinical predictors for prolonged length of stay in the intensive care unit (PLOS-ICU) after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA); and to determine the incidence of PLOS-ICU after DHCA, univariate predictors for PLOS-ICU, and multivariate predictors for PLOS-ICU.

Study Design: A retrospective and observational study. PLOS-ICU was defined as longer than 5 days in the ICU.

Study Setting: Cardiothoracic operating rooms and the ICU.

Participants: All adults requiring thoracic aortic repair with DHCA

Interventions: None.

Main Results: The cohort size was 144. The incidence of PLOS-ICU was 27.8%. The mortality rate was 11.1%. Univariate predictors for PLOS-ICU were age, stroke, DHCA duration, vasopressor dependence >72 hours, mediastinal re-exploration for bleeding, and renal dysfunction. Multivariate predictors for PLOS-ICU were stroke, vasopressor dependence >72 hours, and renal dysfunction.

Conclusions: PLOS-ICU after DHCA is common. The identified multivariate predictors merit further hypothesis-driven research to enhance perioperative protection of the brain, kidney, and cardiovascular system.

Key words: intensive care unit , prolonged stay , deep hypothermic circulatory arrest , thoracic aortic surgery , stroke , vasopressor dependence , renal dysfunction