Atrial Fibrillation on Intensive Care Unit Admission Independently Increases the Risk of Weaning Failure in Nonheart Failure Mechanically Ventilated Patients in a Medical Intensive Care Unit

Abstract

Atrial fibrillation (AF) is one of the most frequent arrhythmias in clinical practice. Previous studies have reported the influence of AF on patients with heart failure (HF). The effect of AF on the non-HF critically ill patients in a medical intensive care unit (ICU) remains largely unclear. The study aimed to investigate the impact of AF presenting on ICU admission on the weaning outcome of non-HF mechanically ventilated patients in a medical ICU.A retrospective observational case–control study was conducted over a 1-year period in a medical ICU at Taipei Veterans General Hospital, a tertiary medical center in north Taiwan. Non-HF mechanically ventilated patients who were successful in their spontaneous breathing trial and underwent ventilator discontinuation were enrolled. The primary outcome measure was the ventilator status after the first episode of ventilator discontinuation.A total of 285 non-HF patients enrolled were divided into AF (n = 62) and non-AF (n = 223) groups. Compared with the non-AF patients, the AF patients were significantly associated with old age (P = 0.002), a higher rate of acute respiratory distress syndrome causing respiratory failure (P = 0.015), a higher percentage of sepsis before liberation from mechanical ventilation (MV) (P = 0.004), and a higher serum level of blood urea nitrogen on the day of liberation from MV (P = 0.003). Multivariate logistic regression analysis demonstrated that AF independently increased the risk of weaning failure [adjusted odds ratio (AOR), 3.268; 95% confidence interval (CI), 1.254–8.517; P = 0.015]. Furthermore, the AF patients were found to be independently associated with a high rate of ventilator dependence (log rank test, P = 0.026), prolonged total ventilator use (AOR, 1.979; 95% CI, 1.032–3.794; P = 0.040), increased length of ICU stay (AOR, 2.256; 95% CI, 1.049–4.849; P = 0.037), increased length of hospital stay (AOR, 2.921; 95% CI, 1.363–6.260; P = 0.006), and increased ICU mortality (AOR, 4.143; 95% CI, 1.381–12.424; P = 0.011).AF on ICU admission is an independent risk factor for weaning failure and significantly associated with poor hospital outcome in non-HF mechanically ventilated patients in a medical ICU.

Current practice in the management of new-onset atrial fibrillation in critically ill patients: a UK-wide survey

“…In the past decades there has been increased attention to new-onset AF in patients in critical care, because it is associated with a worse prognosis ( Chen et al, 2015 ; Shaver et al, 2015 ). Evidence is growing that new-onset AF is associated with longer Intensive Care Unit (ICU) stay and higher mortality ( Reinelt et al, 2001 ; Tseng et al, 2016 ; Yoshida et al, 2015 ). Observational studies suggested that the prevalence of AF in non-cardiac medical ICUs ranges from 5 to 26% ( Carrera et al, 2016 ; Chen et al, 2015 ), and affects up to 10% of patients in surgical ICUs ( Knotzer et al, 2000 ; Seguin et al, 2004 ).…”

New-onset Atrial Fibrillation In Sepsis No Correlation With Inflammatory Cytokines in Real-life Clinical Setting

“…Studies done in the ICU have shown that critically ill patients with new-onset AF have higher mortality and longer hospital stay (12)(13)(14)(15)(16). AF is also associated with mechanical ventilator weaning failure (17). Therefore, we aimed to gain a better understanding of the incidence and investigate whether new-onset AF in sepsis can be explained by increased circulating in ammatory cytokine concentrations.…”

Predictors of early weaning failure from mechanical ventilation in critically ill patients after emergency gastrointestinal surgery

“…Another factor that could prolong MV duration is atrial fibrillation. Tseng et al [ 25 ] and Marcelino et al [ 26 ] showed that atrial fibrillation in patients on ICU admission was an independent risk factor for weaning failure, as well as for poor hospital outcomes.…”