Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review Siyi He, MD, Bocheng Chen, MD, Wei Li, MD, Junyan Yan, MD,

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Ventilator-associated pneumonia after cardiac surgery: A meta-analysis and systematic review Siyi He, MD, Bocheng Chen, MD, Wei Li, MD, Junyan Yan, MD, Lin Chen, MD, Xuefeng Wang, MD, Yingbin Xiao, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 6, Pages 3148-3155.e5 (December 2014) DOI: 10.1016/j.jtcvs.2014.07.107 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow diagram of the study selection process. VAP, Ventilator-associated pneumonia. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Meta-analysis of preoperative risk factors. A, Age; B, gender; C, NYHA cardiac function class IV; D, pulmonary hypertension; E, diabetes mellitus; F, chronic obstructive pulmonary disease; G, peripheral vascular disease; H, renal disease. VAP, Ventilator-associated pneumonia; SD, standard deviation; IV, inverse variance; CI, confidence interval; M-H, Mantel-Haenszel; COPD, chronic obstructive pulmonary disease. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Meta-analysis of intraoperative risk factors. A, Emergency surgery; B, intra-aortic balloon counterpulsation; C, cardiopulmonary bypass time; D, aortic crossclamp time. VAP, Ventilator-associated pneumonia; M-H, Mantel-Haenszel; CI, confidence interval; IABC, intra-aortic balloon counterpulsation; CPB, cardiopulmonary bypass; SD, standard deviation; IV, inverse variance. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Meta-analysis of postoperative risk factors. A, Mechanical ventilation time; B reintervention; C, reintubation. VAP, Ventilator-associated pneumonia; SD, standard deviation; IV, inverse variance; CI, confidence interval; M-H, Mantel-Haenszel. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Meta-analysis of clinical outcomes. A, Mortality; B, length of stay in the intensive care unit. VAP, Ventilator-associated pneumonia; M-H, Mantel-Haenszel; CI, confidence interval; ICU, intensive care unit; SD, standard deviation; IV, inverse variance. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure E4 Funnel plots of each analysis. A, Gender; B, New York Heart Association cardiac function class IV; C, pulmonary hypertension; D, diabetes mellitus; E, chronic obstructive pulmonary disease; F, peripheral vascular disease; G, renal disease; H, emergency surgery; I, intra-aortic balloon counterpulsation; J, cardiopulmonary bypass time; K, aortic crossclamp time; L, mechanical ventilation time; M, reintervention; N, reintubation; O, mortality; P, length of stay in the intensive care unit. SE, Standard error; OR, odds ratio; MD, mean difference. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 3148-3155.e5DOI: (10.1016/j.jtcvs.2014.07.107) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions