Sedation-Ventilation Dyssynchrony Early After Cardiac Surgery Is Associated With Reintubation and Postoperative Complications: A Retrospective Cohort Study With Mediation Analysis.

Authors

Dilek Uçak, Ahmet Çakallıoğlu, Hatice Şimşek Ülkü, Ferid Cereb, Çağla Bali

Published in

Journal of cardiothoracic and vascular anesthesia. Aug 25, 2026. Epub Aug 25, 2026.

Abstract

To evaluate whether early intensive care unit (ICU) sedation-ventilation dyssynchrony (SVD) is associated with reintubation and postoperative complications after cardiac surgery-delirium, postoperative atrial fibrillation, acute kidney injury (AKI), renal replacement therapy, and 30-day mortality-and to explore what proportion of the SVD-AKI association is compatible with mediation by reintubation.
Retrospective single-center cohort study with inverse probability of treatment weighting (IPTW), Fine-Gray competing-risk regression, multiple imputation, and exploratory counterfactual mediation analysis.
Cardiac surgical ICU of a tertiary referral hospital, January 2021 to December 2025.
A total of 3,124 consecutive adult patients undergoing cardiac surgery and admitted intubated to the ICU.
None (observational). The exposure-SVD-was classified within the first 12 hours of ICU stay using the standardized Richmond Agitation-Sedation Scale, Confusion Assessment Method for the ICU, arterial blood gas, and ventilator variables and stratified into 3 mutually exclusive phenotypes: SVD-Deep only, SVD-Light only, and both.
The primary outcome was reintubation within 72 hours of planned extubation. SVD occurred in 780 of 3,124 (25.0%); reintubation occurred in 157 of 3,124 (5.0%). In IPTW-adjusted analyses, SVD was associated with reintubation (adjusted odds ratio [aOR], 3.4; 95% confidence interval [CI], 2.5-4.6), noninvasive ventilation/high-flow nasal cannula rescue (aOR, 2.2), delirium (aOR, 2.6), postoperative atrial fibrillation (aOR, 2.1), AKI (aOR, 2.9), renal replacement therapy (aOR, 3.2), and 30-day mortality (aOR, 2.4); the Fine-Gray subdistribution hazard ratio for reintubation was 3.1 (2.3-4.3). In an exploratory mediation analysis, an estimated 41% (95% CI, 28%-54%) of the SVD-AKI association was compatible with mediation through reintubation; the E-value for the primary association was 6.1.
Early ICU SVD was independently associated with a 3-fold higher adjusted risk of reintubation and with consistent increases across organ-specific complications after cardiac surgery. SVD is identifiable with routinely available bedside variables and warrants prospective multicenter validation before clinical implementation.

PMID:
42731948
Bibliographic data and abstract were imported from PubMed on 13 Sep 2026.

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