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Previous issue date: 2018-10-05 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Objective: To construct a risk score model for prolonged mechanical ventilation (PMV) in patients undergoing coronary after bypass grafting (CABG). Methods: An observational, retrospective and historical cohort study, with 4.165 patients submitted to coronary artery bypass grafting, between January 1996 and December 2016. The duration of ?12 hours on mechanical ventilation defined as prolonged. The multiple logistic regression was used to evaluate the predictor variables. The modeling database, divided in 2/3 of the sample (2.746 patients) generated the preliminary model and its performance was tested in the validation database, divided in 1/3 of the sample (1.419 patients). The final risk score was validated in the total database and the accuracy of the model was tested by performance statistics. Results: The incidence of PMV was 18.8% (783). The variables associated with prolonged PMV were: age ?65 years (OR=1.91; [CI95%=1.62-2.24]; p<0.001); urgent/emergency surgery (OR=2.79; [CI95%=2.09-3.73]; p<0,001); obesity (OR=1.49; [CI95%= 1.21-1.84]; p<0.001); chronic renal failure (OR=1.98; [CI95%=1.61-2.44]; p<0.001); chronic obstructive pulmonary disease (OR=1.43; [CI95%=1.16-1.76];p<0,001) and extracorporeal circulation time ?120 minutes (OR=1.75; [IC95%=1.42-2.16]; p<0.001). The area under de the ROC curve was 0.66 (IC95%=0.64-0.68), the chi-square was 3.38 and the correlation coefficient of r=0.99 (p<0.000). Conclusion: The preoperative predictor variables (age ?65 years, urgent/emergency surgery, obesity, chronic renal failure and chronic obstructive pulmonary disease) and perioperative (extracorporeal circulation time ?120 minutes) were associated with PMV and allowed the constructed of risk score classified in low, medium, high and very high. / Objetivo: Construir um modelo de escore de risco para ventila??o mec?nica prolongada (VMP) em pacientes p?s-cirurgia de revasculariza??o mioc?rdica (CRM).
M?todos: Estudo observacional, retrospectivo e de coorte hist?rica, com 4.165 pacientes submetidos ? CRM, entre janeiro de 1996 a dezembro de 2016. A perman?ncia >12 horas em ventila??o mec?nica foi definida como prolongada. A regress?o log?stica m?ltipla foi utilizada para avaliar as vari?veis preditoras. O banco de dados modelagem, dividido em 2/3 da amostra (2.746 pacientes) gerou o modelo preliminar e seu desempenho foi testado no banco valida??o, dividido em 1/3 da amostra (1.419 pacientes). O escore final foi validado no banco total e a acur?cia do modelo foi testada pelas estat?sticas de desempenho.
Resultados: A incid?ncia de VMP foi de 18,8% (783). As vari?veis associadas ? VMP foram: idade ?65 anos (OR=1,91; [IC95%=1,62-2,24]; p<0,001); cirurgia de urg?ncia/emerg?ncia (OR=2,79; [IC95%=2,09-3,73]; p<0,001); obesidade (OR=1,49; [IC95%= 1,21-1,84]; p<0,001); insufici?ncia renal cr?nica (OR=1,98; [IC95%=1,61-2,44]; p<0,001); doen?a pulmonar obstrutiva cr?nica (OR=1,43; [IC95%=1,16-1,76]; p<0,001) e tempo de circula??o extracorp?rea ?120 minutos (OR=1,75; [IC95%=1,42-2,16]; p<0,001). A ?rea sob a curva ROC foi 0,66 (IC95%=0,64-0,68), o qui-quadrado de 3,38 (p=0,642) e o coeficiente de correla??o de r=0,99 (p<0,000).
Conclus?o: As vari?veis preditoras pr?-operat?rias (idade ?65 anos, cirurgia de urg?ncia/emerg?ncia, obesidade, insufici?ncia renal cr?nica e doen?a pulmonar obstrutiva cr?nica) e perioperat?ria (tempo de circula??o extracorp?rea ?120 minutos) estiveram associadas com a VMP e permitiram a constru??o do escore de risco classificado em baixo, m?dio, alto e muito alto.
| Identifer | oai:union.ndltd.org:IBICT/oai:tede2.pucrs.br:tede/8377 |
| Date | 05 October 2018 |
| Creators | Dallazen, Fernanda |
| Contributors | Bodanese, Luiz Carlos |
| Publisher | Pontif?cia Universidade Cat?lica do Rio Grande do Sul, Programa de P?s-Gradua??o em Medicina e Ci?ncias da Sa?de, PUCRS, Brasil, Escola de Medicina |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da PUC_RS, instname:Pontifícia Universidade Católica do Rio Grande do Sul, instacron:PUC_RS |
| Rights | info:eu-repo/semantics/openAccess |
| Relation | -721401722658532398, 500, 500, 500, 600, -224747486637135387, -969369452308786627, 3590462550136975366 |
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