Facteurs Prédictifs d’une Extubation Différée en Chirurgie Cardiaque

Joseph Koné, Mohamed Amine Elbouaychi, Guy Tsala, Abdoulaye Kossi Diallo, Adil Bensouda

Abstract


RÉSUMÉ
Introduction. En chirurgie cardiaque certains patients requièrent une ventilation prolongée en post opératoire bien que l’extubation précoce soit reconnue favorable à de meilleures suites opératoires. L’objectif de cette étude était d’étudier les facteurs associés à une ventilation prolongée de plus de 240 minutes en postopératoire. Patients et Méthodes. Il s’agissait d’une étude prospective au service de CCV B du CHU Ibn Sina de Rabat sur une période de 6 mois. Nous avons exclu les patients âgés de moins de 18 ans, les cas de pneumopathie avérée et les urgences. Les variables étaient décrites en moyennes± écart-types, médianes-quartiles, et effectifs-pourcentages. L’analyse statistique a été réalisée avec les tests de Khi 2, de Man Whitney avec un risque alpha à 5%. Résultats. Nous avons colligé 55 patients avec un âge moyen de 52,08±13,80 ans, un sexe ratio h/f de 1,39. Dix-sept (17) patients étaient de classes ASA III et IV ; 44 (80,0%) étaient classés NYHA III et IV. Quarante patients (72,7%) ont bénéficié d’une chirurgie valvulaire et 13 (23,6%) d’un pontage aortocoronaire. Un ballon de contre pulsion intra aortique (BCPIA) a été utilisé chez cinq (05) patients. Vingt-neuf (52,7%) étaient extubés dans les 240 minutes, et 26 (42,3%) extubés entre 241 et 1020 minutes. Conclusion. Les facteurs prédictifs d’une extubation différée après chirurgie cardiaque à cœur ouvert étaient la pose d’un BCPIA, l’hypothermie (OR =2,053, CI 95% :2,004-13,023, p=0,028) et les anomalies de la gazométrie (OR=2,054, CI 95% : 2,006-7,530, p=0,012).
ABSTRACT
Introduction. The aim of this study was to determine the predictive factors for a delayed extubation after cardiac surgery in which early extubation is associated with favorable postoperative outcomes. However some patients require prolonged mechanical ventilation. Patients and Methods. It has been six months prospective study performed in the cardiovascular surgery department of Ibn Sina Teaching hospital in Morocco. We have excluded patients less than 18 years old, pulmonary diseases and emergencies. Variables have been described as mean ± standard deviations, medians and quartiles. Statistical test were Khi square, Man Whitney with an alpha error of 5%. Results. We have enrolled 55 patients with a mean age of 52,08±13,80 years and a sex ratio M/F of 1,39. Seventeen (17) patients were from ASA 3 and 4 physical status; 44 (80,0%) where NYHA 3 or 4. There were 40 (72,7%) cases of valve replacement and 13 (23,6%) cases of coronary bypass graft. IABP was used in (05) patients. 29 (52,7%) patients have been extubated within 240 minutes, but 26 (42,3%) have been ventilated between 241 and 1020 minutes before extubation. Conclusion. In our study, the identified predictive factors for delayed extubation were the use of IABP, hypothermia (OR =2,053, CI 95%:2,004-13,023, p=0,028) and arterial blood gas disturbances (OR=2,054, CI 95%: 2,006-7,530, p=0,012).


Keywords


Chirurgie cardiaque, extubation différée, facteurs associés

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References


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