Outcomes Associated with Respiratory Failure for Patients with Cardiogenic Shock and Acute Myocardial Infarction: A Substudy of the CULPRIT-SHOCK Trial

被引:17
|
作者
Gimenez, Maria Rubini [1 ,2 ,3 ]
Miller, P. Elliott [4 ,5 ]
Alviar, Carlos L. [6 ]
van Diepen, Sean [7 ,8 ]
Granger, Christopher B. [9 ]
Montalescot, Gilles [10 ]
Windecker, Stephan [11 ]
Maier, Lars [12 ]
Serpytis, Pranas [13 ,14 ]
Serpytis, Rokas [13 ,14 ]
Oldroyd, Keith G. [15 ]
Noc, Marko [16 ]
Fuernau, Georg [17 ]
Huber, Kurt [18 ,19 ]
Sandri, Marcus [1 ,2 ]
de Waha-Thiele, Suzanne [17 ]
Schneider, Steffen [20 ]
Ouarrak, Taoufik [20 ]
Zeymer, Uwe [21 ,22 ]
Desch, Steffen [1 ,2 ]
Thiele, Holger [1 ,2 ]
机构
[1] Univ Leipzig, Heart Ctr Leipzig, Dept Internal Med Cardiol, D-04289 Leipzig, Germany
[2] Leipzig Heart Inst, D-04289 Leipzig, Germany
[3] Univ Hosp Basel, CRIB, CH-4031 Basel, Switzerland
[4] Yale Univ, Sch Med, Div Cardiovasc Med, 333 Cedar St, New Haven, CT 06520 USA
[5] Yale Natl Clinician Scholars Program, New Haven, CT 06510 USA
[6] NYU, Sch Med, Leon H Charney Div Cardiol, New York, NY 10016 USA
[7] Univ Alberta, Dept Crit Care Med, Edmonton, AB, Canada
[8] Univ Alberta, Dept Med, Div Cardiol, Edmonton, AB, Canada
[9] Duke Clin Res Inst, Cardiol Dept, Durham, NC 27701 USA
[10] Sorbonne Univ, Hop Pitie Salpetriere, AP HP, ACTION Study Grp,Dept Cardiol,Inst Cardiol, F-75013 Paris, France
[11] Univ Bern, Bern Univ Hosp, Inselspital, Dept Cardiol, CH-3010 Bern, Switzerland
[12] Univ Hosp Regensburg, Dept Cardiol, D-93077 Regensburg, Germany
[13] Vilnius Univ, Fac Med, LT-08410 Vilnius, Lithuania
[14] Vilnius Univ Hosp, Santaros Klinikos, LT-08410 Vilnius, Lithuania
[15] Golden Jubilee Natl Hosp, Dept Cardiol, Glasgow G81 4DY, Lanark, Scotland
[16] Univ Med Ctr Ljubljana, Cardiol Dept, Ljubljana 1000, Slovenia
[17] Univ Heart Ctr Luebeck, Cardiol Dept, D-23538 Lubeck, Germany
[18] Wilhelminenhospital, Dept Internal Med Cardiol & Intens Care Med 3, A-2301 Vienna, Austria
[19] Sigmund Freud Univ, Med Sch, A-2301 Vienna, Austria
[20] Inst Herzinfarktforsch, Stat Dept, D-67063 Ludwigshafen, Germany
[21] Hosp City Ludwigshafen, Med Clin B, D-67063 Ludwigshafen, Germany
[22] Inst Herzinfarktforsch, D-67063 Ludwigshafen, Germany
关键词
cardiogenic shock; respiratory failure; mechanical ventilation; non-invasive ventilation; POSITIVE-PRESSURE VENTILATION; MECHANICAL VENTILATION; REVASCULARIZATION; SUPPORT; PEEP;
D O I
10.3390/jcm9030860
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Little is known about clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) requiring mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population. Methods: Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored 30 days of clinical outcomes in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission. Results: Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV had a different risk-profile. Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24 h before admission, elevated heart rate and evidence of triple vessel disease. Conclusions: Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population.
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页数:11
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