Cardiac Arrhythmias in a Septic ICU Population: A Review

Schwartz, A.; Brotfain, Evgeni; Koyfman, Leonid; Klein, Moti

doi:10.1515/jccm-2015-0027

Cited by 22 publications

(26 citation statements)

References 57 publications

(104 reference statements)

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“…In general, patients with severe sepsis were more likely to be older in age, to have CHF, PVD, chronic obstructive pulmonary disease (COPD), DM and renal disease. Ischemic heart disease* 2,161,685 [7] 174,130 [10] CHF* 4,048,500 [14] 427,525 [24] PVD* 1,778,205 [6] 166,975 [10] Cerebrovascular disease* 1,952,330 [7] 144,150 [8] Chronic pulmonary disease* 6,493,627 [22] 495,285 [28] DM* 5,967,546 [21] 499,900 [28] DM with complications* 1,143,775 [4] 127,005 [7] Renal disease* 3,668,071 [13] 465,995 [27] Valvular heart disease* 1,717,610 [6] 131,640 [7] *Comparison between two groups done with Chi-square test. All P values significant at <0.05.…”

Section: Resultsmentioning

confidence: 99%

“…As previous studies have shown, patients with moderate to severe sepsis have a greater likelihood of exhibiting various cardiac arrhythmias (5,6). The majority of these clinical studies were focused on the diagnosis, management, predictors and outcomes of new onset AF in the general intensive care patient population (7). However, studies performed to provide a comprehensive assessment of both atrial and ventricular arrhythmias in severe sepsis patients are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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Background: Although sepsis is a known risk factor for cardiac arrhythmias, data on incidence and outcomes of atrial and ventricular arrhythmias in severe sepsis is limited. The purpose of this study is to examine the association of severe sepsis with cardiac arrhythmias and their impact on outcome in this patient population. Methods:We used hospital discharge data from the Nationwide Inpatient Sample (NIS) during the year 2012. All patients 18 years or older were included in the study. The International Classification of Diseases-Clinical Modification, 9th revision (ICD-9-CM) code was used to identify patients with discharge diagnosis of severe sepsis, atrial fibrillation (A Fib), atrial flutter (AFL), ventricular fibrillation (VF) arrest and non-ventricular fibrillation (non-VF) arrest. In order to study the association of arrhythmias with severe sepsis, two groups were defined: group a-with severe sepsis was compared to group b-without severe sepsis. Univariate and multivariate logistic regression methods were used to adjust for potential confounding factors and variables associated with cardiac arrhythmias were determined.Results: A total of 30,712,524 NIS hospital discharges (weighted for national estimate) were included in our study, of which 1,756,965 (5.7%) had severe sepsis. On multivariate analysis, after adjusting for potential confounders, severe sepsis was associated with higher risk of A Fib (OR, 1.23; 95% CI, 1.21-1.24), AFL (OR, 1.34; 95% CI, 1.30-1.40), VF arrest (OR, 2.58; 95% CI, 2.38-2.79) (OR, 3.31; 95% CI, 3.07-3.57) and non-VF arrest (OR, 4.91; 95% CI,). In the severe sepsis group, cardiac arrhythmia was associated with higher in-hospital mortality (OR, 1.41; 95% CI, 1.37-1.45), length of stay (LOS) >75% quartile (OR, 1.50; 95% CI, 1.46-1.53) and total hospital charges >75% quartile (OR, 1.37; 95% CI, 1.34-1.41). Advanced age, male sex, ischemic heart disease, diabetes mellitus (DM), congestive heart failure (CHF), valvular heart disease, respiratory failure, mechanical ventilation and use of vasopressors were independently associated with cardiac arrhythmias. Conclusions:Patients with severe sepsis are at high risk of atrial and life threatening ventricular arrhythmias. Despite adjustment for potential confounding factors, patients hospitalized with severe sepsis carry a significantly higher risk for cardiac arrest and increased mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Severe sepsis and cardiac arrhythmias

Shahreyar¹,

Fahhoum²,

Akinseye³

et al. 2018

Ann. Transl. Med.

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“…Autonomic dysfunction and tachycardia are associated with a poor outcome in septic shock 2 with mortalities in excess of 70%. 3 Bradycardia is relatively protective.…”

Section: Introductionmentioning

confidence: 99%

Study into the reversal of septic shock with landiolol (beta blockade): STRESS-L Study protocol for a randomised trial

et al. 2021

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IntroductionIn 2013, a single-centre study reported the safe use of esmolol in patients with septic shock and tachycardia who required vasopressor therapy for more than 24 hours. Although not powered to detect a change in mortality, marked improvements were seen in survival (adjusted HR, 0.39; 95% CI, 0.26 to 0.59; p<0.001). Beta blockers are one of the most studied groups of drugs but their effect in septic shock is poorly understood; proposed mechanisms include not only the modulation of cardiac function but also immunomodulation.Methods and analysisSTRESS-L is a randomised, open-label, non-blinded clinical trial which is enrolling a total of 340 patients with septic shock as defined by Sepsis-3 consensus definition and a tachycardia (heart rate ≥95 beats per minute (bpm)) after vasopressor treatment of at least 24 hours. Standard randomisation (1:1 ratio) allocates patients to receive usual care (according to international standards) versus usual care and a continuous landiolol infusion to reduce the heart rate between 80 and 94 bpm. The primary endpoint is the mean Sequential Organ Failure Assessment score over 14 days from entry into the trial and while in intensive care unit. Results will inform current clinical practice guidelines.Ethics and disseminationThis trial has clinical trial authorisation from the UK competent authority, the Medicines and Healthcare products Regulatory Agency, and has been approved by the East of England-Essex Research Ethics Committee (reference: 17/EE/0368).The results of the trial will be reported first to trial collaborators. The main report will be drafted by the trial coordinating team, and the final version will be agreed by the Trial Steering Committee before submission for publication, on behalf of the collaboration.RegistrationThe trial is funded by the National Institute for Health Research Efficacy and Mechanism Evaluation (EME) (Project Number: EME-14/150/85) and registered ISRCTN12600919 and EudraCT: 2017-001785-14.

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“…The review article published in this issue by Schwartz A et al [1] draws attention to the importance of cardiac arrhythmias and especially that of new-onset atrial fibrillation (AF) and the clinical outcome of septic patients. The incidence of this phenomenon varies in different reports, from 5.8% [2] to 31-40% [3][4].…”

mentioning

confidence: 99%

“…An increased inflammatory response also plays an important role in pathogenesis of cardiac arrhythmias and dysfunction in septic patients. Increased plasma levels of C-reactive protein, IL-6 and TNF-α may contribute to the onset of AF in septic patients [1,6].…”

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confidence: 99%

The Significance of Cardiac Arrhythmias in Septic ICU Patients

Ionescu

2015

The Journal of Critical Care Medicine

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Cardiac Arrhythmias in a Septic ICU Population: A Review

Cited by 22 publications

References 57 publications

Severe sepsis and cardiac arrhythmias

Severe sepsis and cardiac arrhythmias

Study into the reversal of septic shock with landiolol (beta blockade): STRESS-L Study protocol for a randomised trial

The Significance of Cardiac Arrhythmias in Septic ICU Patients

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