Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation.

OBJECTIVE:To develop and validate a score for the early identification of cardiac surgery patients at high risk of prolonged mechanical ventilation (MV) who may be suitable targets for interventional trials. DESIGN:Retrospective analysis. SETTING:Tertiary intensive care unit. PARTICIPANTS:Cardiac surgery patients. INTERVENTIONS:Observational study. MEASUREMENTS AND MAIN RESULTS:The study comprised 1,994 patients. Median age was 67 years, and 1,457 patients (74%) were male. Median duration of MV was 9.4 hours. A total of 229 (11%), 182 (9%), and 127 (6%) patients received MV for ≥24, ≥36, and ≥48 hours, respectively. In-hospital mortality was 13%, 15%, and 17%, respectively. For the study model, all preoperative, intraoperative, and early (first 4 hours) postoperative variables were considered. A multivariable logistic regression model was developed, and a predictive scoring system was derived. Using MV ≥24 hours as the primary outcome, the model performance in the development set was good with a c-index of 0.876 (95% confidence interval 0.846-0.905) and a Brier's score of 0.062. In the validation set, the c-index was 0.907 (0.867-0.948), Brier's score was 0.059, and the model remained well calibrated. CONCLUSIONS:The authors developed a simple score to predict prolonged MV after cardiac surgery. This score, if externally validated, is potentially suitable for identifying a high-risk target population for future randomized controlled trials of postoperative care after cardiac surgery.