The Correlation of Fast-track Extubation Ultrasound Score and Clinical Multi-organ Information Indicators of Postoperative of Cardiac Surgery

KANG Hui, ZHANG Zhong-wei, PU Hu-qiong, YIN Wan-hong, XUE Yang, CAO Ge, FAN Jing-xiu, DENG Li-jing,

Abstract

To evaluate the correlation of Fast-track extubation ultrasound score (FTEUS) and clinical multi-organ information indicators in post-cardiac surgery patients.  Methods  prospectively recruit post-cardiac surgery patients who were about to extubating from Febuary 2019 to September 2019. A fast-track extubation ultrasound score protocol (FTE-USP) was developed on the basis of the conventional fast-track extubation standard precisely and individualized. Cardiac, pulmonary and inferior vena cava ultrasound examinations were performed by specially trained observers, video data were saved, FTE-USP was used for scoring, Kendall consistency coefficient was used to meature the interobserver consistency. The correlation between the FTEUS and the patients' clinical indicators was evaluated.  Results  A total of 207 patients were recruited in the study, including 89 males and 118 females, aged (54.63±11.80) years. The FTEUS was performed at bedside with a mean time of (8.23±2.08) min, Kendall consistency coefficient is 0.941. With the increase of the total score of FTEUS, the incidence of clinical adverse events increased (especially the arrhythmia), and there were significant changes in liver, kidney, heart, lung and other organ function indicators, among which serum creatinine level, serum cystatin C level, serum NT-pro-brain natriuretic peptide, length of stay in intensive care unit, non-invasive mechanical ventilation time after extubation, and incidence of arrhythmia were positively correlated with FTEUS (P < 0.05).With FTEUS increased to 5 points, the incidence of arrhythmia (14/24, 58.3%), cardiopulmonary resuscitation (2/24, 8.3%) and weaning failure (2/24, 8.3%) increased.  Conclusion  FTE-USP integrates multi-organ informations, can be performed quickly at the bedside and alerts adverse events. It has the potential to be applied to assist clinical decision-making in post-cardiac surgery patients before extubation.

 

Keywords: Bedside ultrasound, Fast-track extubation, Fast-track extubation ultrasound score, Cardiac surgery, Mechanical ventilation

 

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References


HICKEY R F. CASON В A. Timing of tracheal extubation in adult cardiac surgery patients. J Card Surg, 1995, 10; 340- 348.

ELMER J, LEE S. RITTENBERGER J C,et al. Reintubation in critically ill patients; procedural complications and implications for care. Critical Care, 2015, 16(19) : 12-19.

XIE J. CHENG G, ZHENG Z, et al. To extubate or not to extubate; risk factors for extubation failure and deterioration with further mechanical ventilation. J Card Surg, 2019, 34 (10) ;1004-1011.

GRAWEE, WOJCIECHOWSKI P J, HURFORD W E. Balancing early extubation and rates of reintubation in cardiac surgical patients: where does the fulcrum lie, J Cardiothorac Vase Anesth.2015,29( 3): 549-550.

LEE С W, KORY P D, ARNTFIELD R T. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound. J Crit Care,2016,31( 1) ;96-100.

PICANO E. SC A LI M C, CIAMPI Q. et al. Lung ultrasound for the cardiologist. JACC: Cardiovasc Imaging, 2018, 11 (11) :1692-1705.

JENSEN-URSTAD K, BOUVIER F, HOJER J, et al. Comparison of different echocardiographic methods with radionuclide imaging for measuring left ventricular ejection fraction during acute myocardial infarction treated by thrombolytic therapy. Am J Cardiol, 1998,81(5) ;538-544.

LE NEINDRE A, MONGODI S, PHILIPPART F, et al. Thoracic ullrasound; potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care, 2016-31(1):101-109.

LICHTENSTEIN D A. BLUE-protocol and FALLS- protocol: two applications of lung ultrasound in the critically ill. Chest,2015,147(6): 1659-1670.

SEO Y. I IDA N, YAMAMOTO M, et al. Estimation of central venous pressure using the ratio of short to long diameter from cross-sectional images of the inferior vena cava. J Am Soc Echocardiogr,2017,30(5) :461-467.

LIU J, SHEN F. TEBOUL J L, et al. Cardiac dysfunction induced by weaning from mechanical ventilation; incidence, risk factors,and effects of fluid removal. Crit Care, 2016, 20 (1): 369-383.

FERRE A, GUILLOT M, LICHTENSTEIN D, et al. Lung ultrasound allows the diagnosis of weaning-induced pulmonary oedema. Intensive Care Med, 2019* 45 ( 5 ): 601- 608.

SULLIVAN P G, WALLACH J D. IOANNIDIS J P. Meta¬analysis comparing established risk prediction models ( EuroSCORE H , STS Score, and ACEF Score ) for perioperative mortality during cardiac surgery. Am J Cardiol 2016,118(10):1574-1582.

BAPTISTELLA A R, SARMENTO F J. DA SILVA К R, et al. Predictive factors of weaning from mechanical ventilation and extubation outcome: a systematic review. J Crit Care,2018,48:56-62.

CHAN J L, MILLER J G, MURPHY M, et al. A multidisciplinary protocol-driven approach to improve extubation times after cardiac surgery. Ann Thorac Surg, 2018,105(6);1684-1690.

ROUTSIC, STANOPOULOS I, KOKKORIS S, et al. Weaning failure of cardiovascular origin; how to suspect, detect and treat — a review of the literature. Ann Intensive Care,2019,9<1):6-23.

SOLIMAN S B, RAGAB F, SOLIMAN R A, et al. Chest ultrasound in predication of weaning failure. Open Access Maced J Med Sci,2019,7(7); 1143-1147.

TONGYOO S, THOMRONGPAIROJ P. PERMPIKUL C. Efficacy of echocardiography during spontaneous breathing trial with low-level pressure support for predicting weaning failure among medical critically ill patients. Echocardiography ,2019,36(4): 659-665.

SANFILIPPO F. SANTONOCITO C, BURGIO G, et al. The importance of diastolic dysfunction in the development of weaning-induced pulmonary oedema. Crit Care,2017,21( 1); 29-30.

VIEIL L A RI, В A RON A, EVRARD B, REPESSE X, et al. Limited value of end-expiratory inferior vena cava diameter to predict fluid responsiveness impact of intra-abdominal pressure. Intensive Care Med.2018,44(2); 197-203.


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