Advanced Respiratory Support in the Contemporary Cardiac ICU

Abstract

Supplemental Digital Content is available in the text.

Trends in Therapy and Outcomes Associated With Respiratory Failure in Patients Admitted to the Cardiac Intensive Care Unit

“…[4][5][6]9,10 Our results mirror the recent multicenter CICU study from the CCCTN, and provide relevant data regarding temporal trends. 11 The reasons for increasing noninvasive Data represented as mean + standard deviation for continuous variables and number (percent) for categorical variables. P value is for between-groups analysis of temporal trends across groups using linear regression for continuous variables and logistic regression for categorical variables.…”

“…4 –6,9,10 Our results mirror the recent multicenter CICU study from the CCCTN, and provide relevant data regarding temporal trends. 11 The reasons for increasing noninvasive respiratory support utilization likely include the growing comfort level of cardiovascular specialists with NI-PPV and to a lesser extent the rising prevalence of HF as a cause of respiratory failure; increased familiarity presumably underlies the expanding use of HFNC, which is a relatively newer technology that has gained more widespread acceptance recently. 12,28,29 Conversely, the more frequent use of NI-PPV may have influenced the decrease implementation of IM-PPV.…”

“…Although this referral CICU population may differ from other CICU cohorts in terms of demographics and patient acuity, the prevalence of respiratory failure, use of PPV modalities, and mortality among patients with respiratory failure are consistent with recently-reported CICU studies. 1,11,[32][33][34][35] We could not obtain data on specific causes of respiratory failure, ventilator settings (including adherence to lung-protective ventilation and other best practices), serial blood gas analyses, or other respiratory variables; as such, we could not evaluate changes in practice patterns over time that could have influenced outcomes. The use of ICD-9/10 diagnostic codes to define admission diagnoses lacks granularity and carries some potential limitations when compared to individual review of health records, particularly the inability to capture the primary admission diagnosis and the potential for misdiagnosis; indeed, the potential for shifts in diagnostic coding throughout the study period may have influenced the results.…”

“…2 Studies have reported a prevalence of respiratory failure ranging between 6-25% of CICU patients, with a need for PPV in up to 80% depending on the indication for CICU admission. 2 –11 Given the known effects of PPV on hemodynamics resulting from changes in intrathoracic pressures and the potential for complications from PPV itself, PPV should be used carefully and tailored to the underlying cardiac pathology. 12,13 For these reasons, respiratory failure has been identified as an important predictor of hospital mortality for CICU patients.…”

“…Previous studies on respiratory failure in critically-ill cardiac patients have focused on specific subpopulations or limited periods, without examining the entire CICU population or providing information on temporal changes. 1,3 –6,8 –11 Therefore, we aimed to investigate the prevalence, prevailing trends, and outcomes of patients admitted with respiratory failure in a large historical cohort of tertiary-care CICU patients spanning more than a decade. This epidemiological data on respiratory failure in the CICU population could be leveraged for planning future randomized clinical trials of respiratory support strategies in CICU patients.…”