Pulmonary Hypertension an Independent Risk Factor for Death in Intensive Care Unit: Correlation of Hemodynamic Factors with Mortality
| Autor: | Paul Kleinow, Ghulam Saydain, Safwan Badr, Palaniappan Manickam, Aamir Awan |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Mean arterial pressure lcsh:Diseases of the circulatory (Cardiovascular) system Cardiac index Hemodynamics intensive care unit law.invention lung law Internal medicine pulmonary hypertension Medicine hemodynamic factors Original Research lcsh:RC705-779 APACHE II business.industry Central venous pressure lcsh:Diseases of the respiratory system medicine.disease Intensive care unit Pulmonary hypertension mortality Blood pressure lcsh:RC666-701 Cardiology right ventricular dysfunction Cardiology and Cardiovascular Medicine business Biomedical engineering |
| Zdroj: | Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, Vol 2015, Iss 9, Pp 27-33 (2015) Clinical Medicine Insights. Circulatory, Respiratory and Pulmonary Medicine Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine, Vol 9 (2015) |
| ISSN: | 1179-5484 |
| Popis: | Objective Critically ill patients with pulmonary hypertension (PH) pose additional challenges due to the existence of right ventricular (RV) dysfunction. The purpose of this study was to assess the impact of hemodynamic factors on the outcome. Methods We reviewed the records of patients with a diagnosis of PH admitted to the intensive care unit. In addition to evaluating traditional hemodynamic parameters, we defined severe PH as right atrial pressure >20 mmHg, mean pulmonary artery pressure >55 mmHg, or cardiac index (CI) 2. We also defined the RV functional index (RFI) as pulmonary artery systolic pressure (PASP) adjusted for CI as PASP/CI; increasing values reflect RV dysfunction. Results Fifty-three patients (mean age 60 years, 72% women, 79% Blacks), were included in the study. Severe PH was present in 68% of patients who had higher Sequential Organ Failure Assessment (SOFA) score (6.8 ± 3.3 vs 3.8 ± 1.6; P = 0.001) and overall in-hospital mortality (36% vs 6%; P = 0.02) compared to nonsevere patients, although Acute Physiology and Chronic Health Evaluation (APACHE) II scores (19.9 ± 7.5 vs 18.5 ± 6.04; P = 0.52) were similar and sepsis was more frequent among nonsevere PH patients (31 vs 64%; P = 0.02). Severe PH ( P = 0.04), lower mean arterial pressure ( P = 0.04), and CI ( P = 0.01); need for invasive ventilation ( P = 0.02) and vasopressors ( P = 0.03); and higher SOFA ( P = 0.001), APACHE II ( P = 0.03), pulmonary vascular resistance index (PVRI) ( P = 0.01), and RFI ( P = 0.004) were associated with increased mortality. In a multivariate model, SOFA [OR = 1.45, 95% confidence interval (C.I.) = 1.09-1.93; P = 0.01], PVRI (OR = 1.12, 95% C.I. = 1.02-1.24; P = 0.02), and increasing RFI (OR = 1.06, 95% C.I. = 1.01-1.11; P = 0.01) were independently associated with mortality. Conclusion PH is an independent risk factor for mortality in critically ill patients. Composite factors rather than individual hemodynamic parameters are better predictors of outcome. Monitoring of RV function using composite hemodynamic factors resulting in specific interventions is likely to improve survival and needs to be studied further. |
| Databáze: | OpenAIRE |
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