The impact of invasive respiratory support on the development of postoperative atrial fibrillation following cardiac surgery.

Abstract

STUDY OBJECTIVE\nPostoperative atrial fibrillation (POAF) is a frequent complication after cardiac valve- or coronary artery bypass (CABG) surgery and is associated with increased mortality. While it is known that prolonged postoperative invasive ventilation triggers POAF, the impact of ventilatory settings on POAF development has not been studied yet.\n\n\nDESIGN\nProspective observational study.\n\n\nSETTING\nPostoperative Intensive Care Unit.\n\n\nPATIENTS\nPatients having undergone elective CABG and/or cardiac valve surgery.\n\n\nMEASUREMENTS\nScreening for the development of POAF. Patients clinical data and postoperative ventilatory settings (driving pressure, controlled pressure above positive endexpiratory pressure (PEEP), respiration rate, and FiO2) were investigated to elucidate their impact on POAF.\n\n\nMAIN RESULTS\nOut of 441 enrolled individuals, a total of 192 participants developed POAF (43.5%). We observed that POAF patients received a higher peak driving pressure, and a higher peak respiration rate than non-POAF individuals. Within the multivariate regression model, plateau pressure (adjusted OR 1.199 [1.038-1.661], p\xa0=\xa00.019), driving pressure (adjusted OR 1.244 [1.103-1.713], p\xa0=\xa00.021), and peak respiration rate (adjusted OR 1.206 [1.005-1.601], p\xa0=\xa00.040) proved to be independently associated with the development of POAF. CART analysis revealed a cut-off of ≥17.5 cmH2O of plateau pressure, ≥11.5 cmH2O of driving pressure and\xa0≥\xa017 respirations per minute as high-risk for POAF development.\n\n\nCONCLUSIONS\nThe ventilatory settings of plateau pressure, driving pressure, and respiration rate after cardiac surgery influence POAF occurrence probability. Optimized postoperative care such as lung-protective ventilation and increased awareness towards postoperative ventilatory efforts should be considered to prevent POAF development and poor patient outcome.