Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support?
Abstract
:1. Introduction
2. Methods
2.1. Setting and Study Population
2.2. Study Variables and Endpoints
2.3. Exposure
2.4. Statistical Analyses
3. Results
4. Discussion
4.1. Principal Findings
4.2. Other Literature
4.3. Limitations and Speculation
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
References
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Variable Name | All (N = 397) | ETISO < 0.5MAC, 30 min (N = 171) | ETISO ≥ 0.5MAC, 30 min (N = 226) | p-Value | |
---|---|---|---|---|---|
Baseline Characteristics | |||||
Age (mean ± SD) | 64.85 ± 10.91 | 66.04 ± 9.70 | 63.96 ± 11.69 | 0.054 | |
Male sex | 282 (71%) | 125 (73%) | 157 (69%) | 0.430 | |
BMI (mean ± SD) | 29.49 ± 7.14 | 29.64 ± 8.67 | 29.37 ± 5.75 | 0.728 | |
ASA 4 | 353 (89%) | 158 (92%) | 195 (87%) | 0.069 | |
Type of Surgery | |||||
CABG only | 209 (53%) | 92 (54%) | 117 (52%) | 0.754 | |
Combined CABG plus valve | 97 (24%) | 44 (26%) | 53 (23%) | ||
Valve | 63 (16%) | 25 (15%) | 38 (17%) | ||
Thoracic Aorta | 28 (7%) | 10 (6%) | 18 (8%) | ||
Creatinine Clearance (Mean ± SD) | 87.13 ± 40.75 | 89.11 ± 37.39 | 85.63 ± 43.13 | 0.392 | |
Pulmonary Hypertension | |||||
None | 254 (64%) | 109 (64%) | 145 (64%) | 0.828 | |
Moderate (PA Systolic 31–55 mmHg) | 125 (31%) | 53 (31%) | 72 (32%) | ||
Severe (PA Systolic > 55 mmHg) | 18 (5%) | 9 (5%) | 9 (4%) | ||
Extracardiac Arteriopathy | 28 (7%) | 7 (4%) | 21 (9%) | 0.045 | |
Poor Mobility | 3 (1%) | 0 (0%) | 3 (1%) | 0.130 | |
COPD | 38 (10%) | 23 (13%) | 15 (7%) | 0.022 | |
Active Endocarditis | 5 (1%) | 1 (1%) | 4 (2%) | 0.294 | |
Critical Preoperative State | 7 (2%) | 1 (1%) | 6 (3%) | 0.121 | |
Previous Cardiac Surgery | 22 (6%) | 10 (6%) | 12 (5%) | 0.816 | |
Class 4 Angina | 21 (5%) | 10 (6%) | 11 (5%) | 0.666 | |
MI within 90 days | 62 (16%) | 23 (13%) | 39 (17%) | 0.301 | |
Ejection Fraction % (mean ± SD) | 54.42 ± 11.74 | 55.23 ± 11.48 | 53.81 ± 11.92 | 0.232 | |
Diabetes on Insulin | 115 (29%) | 43 (25%) | 72 (32%) | 0.144 | |
Hypertension | 332 (84%) | 144 (84%) | 188 (83%) | 0.785 | |
Stroke | 19 (5%) | 8 (5%) | 11 (5%) | 0.930 | |
Euroscore II (mean ± SD) | 2.81 ± 3.37 | 2.35 ± 2.55 | 3.16 ± 3.85 | 0.013 | |
Coronary Artery Disease | 320 (81%) | 142 (83%) | 178 (79%) | 0.286 | |
Moderate or Severe Valve Disease | 188 (47%) | 77 (45%) | 111 (49%) | 0.419 | |
History of Smoking | 225 (57%) | 96 (56%) | 129 (57%) | 0.852 | |
Vasopressor Pre-Bypass | 115 (29%) | 43 (25%) | 72 (32%) | 0.144 | |
CPB time in hours (mean ± SD) | 2.84 ± 1.21 | 2.74 ± 1.08 | 2.92 ± 1.29 | 0.122 | |
Postoperative Events | |||||
Acute Kidney Injury | 106 (27%) | 50 (29%) | 56 (25%) | 0.320 | |
ICU days (mean ± SD) | 140 (35%) | 56 (33%) | 84 (37%) | 0.361 | |
Acute Kidney Injury | 5.26 ± 6.90 | 5.04 ± 7.84 | 5.42 ± 6.11 | 0.446 | |
Hospital Stay (mean ± SD) | 10.96 ± 10.56 | 10.16 ± 8.46 | 11.56 ± 11.89 | 0.202 |
Variable | All (N = 397) | Inotrope or Vasopressor USED (N = 32) | Inotrope or Vasopressor NOT USED (N = 365) | p-Value | |
---|---|---|---|---|---|
Baseline Characteristics | |||||
Volatile Exposure (ETISO ≥ 0.5MAC, 30 min) | 226 (57%) | 12 (38%) | 214 (59%) | 0.021 | |
Age (mean ± SD) | 64.85 ± 10.91 | 60.28 ± 10.57 | 65.25 ± 10.86 | 0.013 | |
Male sex | 282 (71%) | 28 (88%) | 254 (70%) | 0.032 | |
BMI (mean ± SD) | 29.49 ± 7.14 | 28.62 ± 4.30 | 29.56 ± 7.34 | 0.272 | |
ASA 4 | 353 (89%) | 28 (88%) | 325 (89%) | 0.756 | |
Type of Surgery | |||||
CABG only | 209 (53%) | 26 81%) | 183 (50%) | 0.005 | |
Combined CABG plus valve | 97 (24%) | 1 (3%) | 96 (26%) | ||
Valve | 63 (16%) | 3 (9%) | 60 (16%) | ||
Thoracic Aorta | 28 (7%) | 2 (6%) | 26 (7%) | ||
Pulmonary Hypertension | |||||
None | 254 (64%) | 30 (94%) | 224 (61%) | 0.001 | |
Moderate (PA Systolic 31–55 mgHg) | 125 (31%) | 2 (6%) | 123 (34%) | ||
Severe (PA Systolic > 55 mmHg) | 18 (5%) | 0 (0%) | 18 (5%) | ||
Creatinine Clearance (Mean ± SD) | 87.13 ± 40.75 | 107.89 ± 41.40 | 85.31 ± 40.24 | 0.003 | |
Extracardiac Arteriopathy | 28 (7%) | 1 (3%) | 27 (7%) | 0.365 | |
Poor Mobility | 3 (1%) | 0 (0%) | 3 (1%) | 0.607 | |
COPD | 38 (10%) | 1 (3%) | 37 (10%) | 0.196 | |
Active Endocarditis | 5 (1%) | 0 (0%) | 5 (1%) | 0.505 | |
Critical Preoperative State | 7 (2%) | 0 (0%) | 7 (2%) | 0.429 | |
Previous Cardiac Surgery | 22 (6%) | 0 (0%) | 22 (6%) | 0.153 | |
Class 4 Angina | 21 (5%) | 3 (9%) | 18 (5%) | 0.282 | |
MI within 90 days | 62 (16%) | 4 (13%) | 58 (16%) | 0.612 | |
Ejection Fraction % (mean ± SD) | 54.42 ± 11.74 | 55.44 ± 11.51 | 54.33 ± 11.77 | 0.609 | |
Diabetes on Insulin | 115 (29%) | 5 (16%) | 110 (30%) | 0.083 | |
Hypertension | 332 (84%) | 27 (84%) | 305 (84%) | 0.905 | |
Stroke | 19 (5%) | 1 (3%) | 18 (5%) | 0.646 | |
Euroscore II (mean ± SD) | 2.81 ± 3.37 | 1.04 ± 0.56 | 2.97 ± 3.47 | <0.001 | |
Coronary Artery Disease | 320 (81%) | 26 (81%) | 294 (81%) | 0.923 | |
Moderate or Severe Valve Disease | 188 (47%) | 7 (22%) | 181 (50%) | 0.003 | |
History of Smoking | 225 (57%) | 14 (44%) | 211 (58%) | 0.124 | |
Vasopressor Pre-Bypass | 115 (29%) | 5 (16%) | 110 (30%) | 0.083 | |
CPB time in hours (mean ± SD) | 2.84 ± 1.21 | 2.11 ± 0.65 | 2.91 ± 1.22 | <0.001 | |
Postoperative Events | |||||
Atrial Fibrillation | 106 (27%) | 4 (13%) | 102 (28%) | 0.058 | |
Acute Kidney Injury | 140 (35%) | 7 (22%) | 133 (36%) | 0.098 | |
ICU days (mean ± SD) | 5.26 ± 6.90 | 3.03 ± 0.97 | 5.45 ± 7.16 | 0.006 | |
Hospital Stay (mean ± SD) | 10.96 ± 10.56 | 6.88 ± 2.46 | 11.32 ± 10.92 | <0.001 | |
Time to extubation in hours (mean ± SD) | 20.38 ± 48.97 | 7.62 ± 7.35 | 21.50 ± 50.88 | <0.001 | |
Duration of vasopressor support in ICU in hours (mean ± SD) | 46.65 ± 85.18 | 0.00 ± 0.00 | 50.74 ± 87.66 | <0.001 |
Variable/Category | Odds Ratio (95% C.I.) | p-Value |
---|---|---|
Age (per decade) | 0.77 (0.63, 0.95) | 0.016 |
ASA Physical Status (4 vs. 3) | 0.47 (0.23, 0.94) | 0.033 |
Euroscore II (per 1 unit) | 1.10 (1.02, 1.20) | 0.015 |
COPD (Yes vs. No) | 0.40 (0.19, 0.81) | 0.011 |
Extracardiac Arteriopathy (Yes vs. No) | 2.40 (0.97, 5.95) | 0.059 |
Variable | Odds Ratio (95% C.I.) | p-Value |
---|---|---|
Volatile Exposure (ETISO ≥ 0.5MAC, 30 min) | 2.49 (1.15, 5.38) | 0.021 |
Age (decades) | 1.59 (1.13, 2.24) | 0.008 |
Sex (Male vs. Female) | 0.33 (0.11, 0.96) | 0.042 |
Surgery: Combined CABG plus Valve | 14.80 (1.96, 111.5) | 0.009 |
Moderate to Severe Valve Disease | 3.65 (1.51, 8.79) | 0.004 |
Pulmonary Hypertension | 9.90 (2.32, 42.29) | 0.002 |
Creatinine Clearance | 0.99 (0.98, 1.00) | 0.003 |
CPB time (hours) | 2.56 (1.52, 4.32) | <0.001 |
Surgery: Thoracic Aorta | 1.91 (0.41, 8.87) | 0.410 |
Surgery: Valve | 2.94 (0.85, 10.21) | 0.090 |
Class 4 Angina | 0.53 (0.15, 1.95) | 0.341 |
Extracardiac Arteriopathy | 2.84 (0.34, 24.10) | 0.338 |
COPD | 4.50 (0.53, 38.37) | 0.169 |
ASA (4 vs. 3) | 1.24 (0.37, 4.20) | 0.731 |
Ejection Fraction | 0.99 (0.96, 1.03) | 0.651 |
Diabetes Mellitus on Insulin | 2.25 (0.84, 6.05) | 0.107 |
Hypertension | 0.93 (0.34, 2.54) | 0.892 |
Stroke | 1.81 (0.22, 14.59) | 0.579 |
Vasopressor Pre-Bypass | 2.16 (0.81, 5.79) | 0.126 |
Variable | Odd Ratio (95% C.I) | p-Value |
---|---|---|
CPB time (hours) | 1.86 (1.02, 3.40) | 0.042 |
Pulmonary Hypertension | 5.90 (1.33, 26.28) | 0.020 |
Euroscore II | 2.73 (1.35, 5.50) | 0.005 |
Volatile Exposure (ETISO ≥ 0.5MAC, 30 min) | 2.57 (1.15, 5.76) | 0.021 |
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Lenk, T.A.; Guerra-Londono, C.E.; Graul, T.E.; Murinson, M.A.; Hehar, P.K.; Divine, G.; Modak, R.K. Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support? Hearts 2021, 2, 213-223. https://doi.org/10.3390/hearts2020017
Lenk TA, Guerra-Londono CE, Graul TE, Murinson MA, Hehar PK, Divine G, Modak RK. Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support? Hearts. 2021; 2(2):213-223. https://doi.org/10.3390/hearts2020017
Chicago/Turabian StyleLenk, Tara A., Carlos E. Guerra-Londono, Thomas E. Graul, Marc A. Murinson, Prabhdeep K. Hehar, George Divine, and Raj K. Modak. 2021. "Is Greater Than 0.5 MAC Inhalational Agent Use Post-Bypass Related to Need for Inotropic and/or Vasoconstrictor Support?" Hearts 2, no. 2: 213-223. https://doi.org/10.3390/hearts2020017