Predictors of prolonged use of mechanical ventilation in patients with acute respiratory failure and acute heart failure in the CVCU RSUD Dr. Saiful Anwar Malang
Abstract
Background
Acute respiratory failure (ARF) is a critical condition that often complicates hospitalization and commonly arises from cardiopulmonary dysfunctions such as acute heart failure. Prolonged mechanical ventilation (PMV) in these patients is associated with increased morbidity, mortality of about 30%, and greater healthcare resource utilization. Identifying predictors of PMV is essential to improve outcomes and optimize management strategies.
Methods
A retrospective cohort study was conducted on all patients who underwent endotracheal intubation in the Cardiovascular Care Unit (CVCU) of RSUD Dr. Saiful Anwar Malang from 2015 to 2021. Patients with incomplete medical records or who died within 14 days of mechanical ventilation were excluded. Univariate and multivariate logistic regression analyses identified independent predictors of PMV. Receiver operating characteristic (ROC) curves were generated to assess model discrimination using the area under the curve (AUC), with corresponding sensitivity and specificity. Data were analyzed using SPSS 22.0.
Results
Five independent predictors of PMV were identified: tachycardia (p = 0.013), metabolic acidosis (p = 0.002), impaired renal function (p = 0.009), shock (p = 0.006), and major bleeding (p = 0.002). Multivariate analysis showed the following odds ratios
(OR, 95% CI): tachycardia 2.06 (1.09–5.99), metabolic acidosis 2.03 (1.09–6.33), impaired renal function 2.87 (1.28–6.46), shock 2.83 (1.13–7.06), and major bleeding 1.36 (1.18–2.15). The model demonstrated good discrimination with an AUC of 0.83 (95% CI 0.77–0.88), sensitivity 0.87, and specificity 0.73.
Conclusion
In patients with respiratory failure due to acute heart failure, tachycardia, metabolic acidosis, impaired renal function, shock, and major bleeding were independent predictors of prolonged mechanical ventilation. The predictive model showed high sensitivity and acceptable specificity, supporting its clinical usefulness for early identification of high-risk patients and targeted intervention.
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References
Kuhn BT, Bradley LA, Dempsey TM, Puro AC, Adams JY. Management of mechanical ventilation in decompensated heart failure. Journal of cardiovascular development and disease. 2016;3(4):33.
Cherpanath T, Lagrand W, Schultz M, Groeneveld A. Cardiopulmonary interactions during mechanical ventilation in critically ill patients. Netherlands Heart Journal. 2013;21(4):166-72.
Pham T, Brochard LJ, Slutsky AS, editors. Mechanical ventilation: state of the art. Mayo Clinic Proceedings; 2017: Elsevier.
Alviar CL, Miller PE, McAreavey D, Katz JN, Lee B, Moriyama B, et al. Positive pressure ventilation in the cardiac intensive care unit. Journal of the American College of Cardiology. 2018;72(13):1532-53.
Alviar CL, Rico-Mesa JS, Morrow DA, Thiele H, Miller PE, Maselli DJ, et al. Positive pressure ventilation in cardiogenic shock: review of the evidence and practical advice for patients with mechanical circulatory support. Canadian Journal of Cardiology. 2020;36(2):300-12.
Bayram B, Şancı E. Invasive mechanical ventilation in the emergency department. Turkish Journal of Emergency Medicine. 2019;19(2):43-52.
Clark PA, Lettieri CJ. Clinical model for predicting prolonged mechanical ventilation. Journal of critical care. 2013;28(5):880. e1-. e7.
Gadre S.K. DA, Mireles C.E., Krishnan S., Wang X.F, Zell K. Acute Respiratory Failure Requiring Mechanical Ventilation. Medicine (Baltimore). 2018(97 (17)):487.
de Meirelles Almeida C, Nedel W, Morais V, Boniatti M, de Almeida-Filho O. Diastolic dysfunction as a predictor of weaning failure: a systematic review and meta-analysis. Journal of Critical Care. 2016;34:135-41.
Teboul J-L. Weaning-induced cardiac dysfunction: where are we today? Intensive care medicine. 2014;40(8):1069-79.
Routsi C, Stanopoulos I, Kokkoris S, Sideris A, Zakynthinos S. Weaning failure of cardiovascular origin: how to suspect, detect and treat—a review of the literature. Annals of Intensive Care. 2019;9(1):1-17.
Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. European Respiratory Journal. 2007;29(5):1033-56.
Ghiani A, Paderewska J, Sainis A, Crispin A, Walcher S, Neurohr C. Variables predicting weaning outcome in prolonged mechanically ventilated tracheotomized patients: a retrospective study. Journal of intensive care. 2020;8(1):1-10.
Ghiani A, Paderewska J, Walcher S, Tsitouras K, Neurohr C, Kneidinger N. Mechanical power normalized to lung-thorax compliance indicates weaning readiness in prolonged ventilated patients. Scientific reports. 2022;12(1):1-9.
Maggiore SM, Lellouche F, Pignataro C, Girou E, Maitre B, Richard J-CM, et al. Decreasing the adverse effects of endotracheal suctioning during mechanical ventilation by changing practice. Respiratory care. 2013;58(10):1588-97.
Hammash MH. Cardiac rhythm during mechanical ventilation and weaning from ventilation: University of Kentucky; 2010.
Cairo JM. Pilbeam's mechanical ventilation: physiological and clinical applications: Elsevier Health Sciences; 2015.
Bellomo R, Kellum JA. CHAPTER 14 - Acid-Base Balance and Kidney-Lung Interaction. In: Papadakos PJ, Lachmann B, Visser-Isles L, editors. Mechanical Ventilation. Philadelphia: W.B. Saunders; 2008. p. 158-72.
Imai Y, Parodo J, Kajikawa O, de Perrot M, Fischer S, Edwards V, et al. Injurious mechanical ventilation and end-organ epithelial cell apoptosis and organ dysfunction in an experimental model of acute respiratory distress syndrome. Jama. 2003;289(16):2104-12.
Kimura N, Tanaka M, Kawahito K, Sanui M, Yamaguchi A, Ino T, et al. Risk factors for prolonged mechanical ventilation following surgery for acute type a aortic dissection. Circulation Journal. 2008;72(11):1751-7.
Liu J, Shen F, Teboul J-L, Anguel N, Beurton A, Bezaz N, et al. Cardiac dysfunction induced by weaning from mechanical ventilation: incidence, risk factors, and effects of fluid removal. Critical care. 2016;20(1):1-14.
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