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

Abstract

Purpose: To describe the epidemiology, outcomes, and temporal trends of respiratory failure in the cardiac intensive care unit (CICU). Materials and Methods: Retrospective cohort analysis of 2,986 unique Mayo Clinic CICU patients from 2007 to 2018 with respiratory failure. Temporal trends were analyzed, along with hospital and 1-year mortality. Multivariable logistic regression was used to determine adjusted hospital mortality trends. Results: The prevalence of respiratory failure in the CICU increased from 15% to 38% during the study period ( P < 0.001 for trend). Among patients with respiratory failure, the utilization of invasive ventilation decreased and noninvasive ventilation modalities increased over time. Hospital mortality and 1-year mortality were 24% and 54%, respectively, with variation according to the type of respiratory support (highest among patients receiving invasive ventilation alone: 35% and 46%, respectively). Hospital mortality was highest among patients with concomitant cardiac arrest and/or shock (52% for patients with both). Hospital mortality decreased in the overall population from 35% to 25% ( P < 0.001 for trend), but was unchanged among patients receiving positive-pressure ventilation. Conclusions: The prevalence of respiratory failure in CICU more than doubled during the last decade. The use of noninvasive respiratory support increased, while overall mortality declined over time. Cardiac arrest and shock accounted for the majority of deaths. Further research is needed to optimize the outcomes of high-risk CICU patients with respiratory failure.

Cardiovascular Critical Care Training: A Collaboration between Intensivists and Cardiologists

“…This population was frequently treated with advanced therapies: approximately 27% of CICU patients required positive pressure ventilation, 31% of those in shock were treated with MCS, and 36% of the total cohort required vasoactive infusions ( 5 ). Substantiating the data from the CCCTN, a large cohort study of patients admitted to a tertiary care CICU identified more than a doubling in the rate of respiratory failure over a decade, with more than 50% of patients requiring invasive mechanical ventilation ( 14 ).…”

Heart Failure-Related Cardiogenic Shock: Pathophysiology, Evaluation and Management Considerations

“…2,39 Respiratory Failure Respiratory failure is common in patients with CS, and its prevalence has more than doubled over the past 10 years. 40 In a multivariable logistic regression analysis of HF trials, the requirement for mechanical ventilation (MV) was strongly associated with increased 30-day rehospitalization and all-cause mortality. 41 Positive pressure ventilation (PPV), including MV and noninvasive positive pressure ventilation (NI-PPV), has complex effects on cardiopulmonary physiology.…”

Mechanical ventilation in patients with cardiogenic pulmonary edema: a sub-analysis of the LUNG SAFE study

“…Mortality rates in cardiogenic pulmonary edema and cardiogenic shock remain high, with only minor improvements in the last years [ 5 , 6 ]. Patients with CPE that need mechanical ventilation constitute a subgroup with a significant mortality [ 7 – 9 ], and the incidence of respiratory failure within patients admitted to cardiac intensive care units may be increasing [ 10 , 11 ].…”