{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:38:30Z","timestamp":1775572710525,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Enhancing recovery after cardiac surgery involves minimally invasive procedures, early extubation\/mobilization, and swift discharge. While mechanical ventilation is often essential post-operation, prolonged invasive ventilation (IMV) increases mortality risk. Duration is influenced by patient factors (age and comorbidities), surgical complexity, and complications. Prognostic scores like EuroSCORE II, sequential organ failure assessment (SOFA), the Charlson Comorbidity Index (CCI), and the vasoactive\u2013inotropic score (VIS) help to predict ventilation needs. The aim of this study is to analyze the effect of pre-\/post-operation factors and procedure type as predictors of ventilation time. Materials and Methods: This is a retrospective cohort observational study analyzing factors affecting the duration of postoperative mechanical ventilation in elective cardiac surgical patients treated between 1 January and 31 December 2024 in a tertiary center in continental Croatia. Patients were stratified into two groups according to the duration of IMV: normal (first three quartiles) and prolonged (upper quartile). In total, 493 elective cardiac surgical patients operated on under general endotracheal anesthesia with sternotomy or mini-sternotomy were admitted postoperatively to the cardiovascular ICU and mechanically ventilated during the observed period, and 463 patients were included in the final analysis after the exclusion criteria had been applied. Results: The mean age was 64.7 \u00b1 9.8 years, and 28.7% of the cohort were females while 71.3% were males. The median Charlton Comorbidity Index was 4 (IQR 3\u20135), the VIS was 2 (IQR 0\u20133), the SOFA score at ICU admission was 5 (IQR 3\u20136), and the adjusted SOFA score was 3 (IQR 2\u20134). In the multivariate logistic regression model, a significant effect of female sex (OR 1.98), age (OR 1.05), VIS (OR 1.05), and history of previous cardiac surgery (OR 6.67) on the duration of mechanical ventilation was observed. In the time-to-extubation multivariate analysis, there was a significant effect of re-do surgery (HR 3.70), corrected SOFA score (HR 1.14), and VIS (HR 1.05) on the duration of mechanical ventilation. There was no significant effect of the type of surgery (CABG, aorta, aortic valve, mitral\/tricuspid valve, or other) or the amount of chest tube drainage on the duration of mechanical ventilation. Conclusions: A history of previous cardiac surgery and the vasoactive\u2013inotropic score during the first 24 postoperative hours in the ICU are the strongest predictors of the duration of mechanical ventilation after elective cardiac surgery, with a statistically significant effect present in both the logistic regression model and hazard ratio analysis. Further analyses with more variables are warranted in the future to refine the prognostic model.<\/jats:p>","DOI":"10.3390\/medicina61101778","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T09:37:21Z","timestamp":1759311441000},"page":"1778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["ICU Admission-Related Factors Affecting the Duration of Mechanical Ventilation After Elective Cardiac Surgery\u2014Retrospective Cohort Study from a Tertiary Center in Croatia"],"prefix":"10.3390","volume":"61","author":[{"given":"Darko","family":"Kristovi\u0107","sequence":"first","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2362-4444","authenticated-orcid":false,"given":"Verica","family":"Mikecin","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana","family":"Prese\u010dki","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8580-2357","authenticated-orcid":false,"given":"Zrinka","family":"\u0160afari\u0107 Oremu\u0161","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0474-7780","authenticated-orcid":false,"given":"Nata\u0161a","family":"Soj\u010di\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0197-0741","authenticated-orcid":false,"given":"Ivan","family":"Gospi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hrvoje","family":"Lasi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanja","family":"Sakan","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"LKH Universit\u00e4tsklinikum Graz, 8036 Graz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danijela","family":"Kralj Husajna","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7653-1698","authenticated-orcid":false,"given":"Nikola","family":"Bradi\u0107","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"Department of Nursing, University North, 42000 Vara\u017edin, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3777-8153","authenticated-orcid":false,"given":"Jasminka","family":"Per\u0161ec","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"Department of Nursing, University North, 42000 Vara\u017edin, Croatia"},{"name":"University of Zagreb, School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6517-9895","authenticated-orcid":false,"given":"Andrej","family":"\u0160ribar","sequence":"additional","affiliation":[{"name":"Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, 10000 Zagreb, Croatia"},{"name":"University of Zagreb, School of Dental Medicine, 10000 Zagreb, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Goecke, S., Pitts, L., Dini, M., Montagner, M., Wert, L., Akansel, S., Kofler, M., Stoppe, C., Ott, S., and Jacobs, S. (2025). Enhanced Recovery After Cardiac Surgery for Minimally Invasive Valve Surgery: A Systematic Review of Key Elements and Advancements. Medicina, 61.","DOI":"10.3390\/medicina61030495"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.bja.2020.06.037","article-title":"Fully Automated Postoperative Ventilation in Cardiac Surgery Patients: A Randomised Clinical Trial","volume":"125","author":"Neto","year":"2020","journal-title":"Br. J. Anaesth."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1186\/s13063-024-08296-2","article-title":"POStoperative INTELLiVENT-Adaptive Support VEntilation in Cardiac Surgery Patients (POSITiVE) II-Study Protocol of a Randomized Clinical Trial","volume":"25","author":"Bernardi","year":"2024","journal-title":"Trials"},{"key":"ref_4","first-page":"244","article-title":"Association of Respiratory Mechanics with Oxygenation and Duration of Mechanical Ventilation After Cardiac Surgery","volume":"31","author":"Cordeiro","year":"2018","journal-title":"Int. J. Cardiovasc. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.21037\/jtd-22-233","article-title":"A Study of Mechanical Ventilation in the ICU after Cardiac Surgery: A Bibliometric Analysis","volume":"14","author":"Zhang","year":"2022","journal-title":"J. Thorac. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.1378\/chest.123.4.1229","article-title":"Application of the Sequential Organ Failure Assessment Score to Cardiac Surgical Patients","volume":"123","author":"Ceriani","year":"2003","journal-title":"Chest"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Chang, C.-H., Chen, S.-W., Fan, P.-C., Lee, C.-C., Yang, H.-Y., Chang, S.-W., Pan, H.-C., Tsai, F.-C., Yang, C.-W., and Chen, Y.-C. (2017). Sequential Organ Failure Assessment Score Predicts Mortality after Coronary Artery Bypass Grafting. BMC Surg., 17.","DOI":"10.1186\/s12893-017-0219-9"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Schoe, A., Bakhshi-Raiez, F., de Keizer, N., van Dissel, J.T., and de Jonge, E. (2020). Mortality Prediction by SOFA Score in ICU-Patients after Cardiac Surgery; Comparison with Traditional Prognostic\u2013Models. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-00975-2"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A New Method of Classifying Prognostic Comorbidity in Longitudinal Studies: Development and Validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Baris, O., Oksuzler Kizilbay, G., Holat, C.M., Uzturk, M.E., Canikoglu, M., Durmaz, A., Omay, O., and Yavuz, S. (2025). The Efficacy of the Charlson Comorbidity Index and Its Age-Adjusted Version in Forecasting Mortality and Postoperative Outcomes Following Isolated Coronary Artery Bypass Grafting. J. Clin. Med., 14.","DOI":"10.3390\/jcm14020395"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.bja.2018.12.019","article-title":"Vasoactive-Inotropic Score and the Prediction of Morbidity and Mortality after Cardiac Surgery","volume":"122","author":"Koponen","year":"2019","journal-title":"BJA Br. J. Anaesth."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s13643-023-02403-1","article-title":"The Association of Vasoactive-Inotropic Score and Surgical Patients\u2019 Outcomes: A Systematic Review and Meta-Analysis","volume":"13","author":"Sun","year":"2024","journal-title":"Syst. Rev."},{"key":"ref_13","unstructured":"(2025, June 15). The Jamovi Project. Jamovi. Available online: www.jamovi.org."},{"key":"ref_14","unstructured":"Balci, S. (2025, June 15). Comprehensive Analysis for Clinicopathological Research 2025. Available online: https:\/\/www.serdarbalci.com\/ClinicoPathJamoviModule\/."},{"key":"ref_15","unstructured":"Therneau, T.M., Lumley, T., Atkinson, E., and Crowson, C. (Survival: Survival Analysis, 2004). Survival: Survival Analysis, version 3.8-3."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jtcvs.2016.08.020","article-title":"A Derived and Validated Score to Predict Prolonged Mechanical Ventilation in Patients Undergoing Cardiac Surgery","volume":"153","author":"Sharma","year":"2017","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1053\/j.jvca.2008.08.007","article-title":"The inflammatory response to cardiopulmonary bypass: Part 1\u2014Mechanisms of pathogenesis","volume":"23","author":"Warren","year":"2009","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s13019-024-03247-z","article-title":"Factors Affecting the Prolongation of Mechanical Ventilation in Patients after Cardiac Surgery","volume":"20","author":"Kermani","year":"2025","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2709","DOI":"10.1053\/j.jvca.2019.03.009","article-title":"Development and Validation of a Score to Identify Cardiac Surgery Patients at High Risk of Prolonged Mechanical Ventilation","volume":"33","author":"Hessels","year":"2019","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"550","DOI":"10.4187\/respcare.04915","article-title":"Prolonged Mechanical Ventilation as a Predictor of Mortality After Cardiac Surgery","volume":"63","year":"2018","journal-title":"Respir. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s00134-012-2799-2","article-title":"Evaluation of Fully Automated Ventilation: A Randomized Controlled Study in Post-Cardiac Surgery Patients","volume":"39","author":"Lellouche","year":"2013","journal-title":"Intensive Care Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T10:16:39Z","timestamp":1759313799000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/10\/1778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":21,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["medicina61101778"],"URL":"https:\/\/doi.org\/10.3390\/medicina61101778","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}