scholarly journals Weaning of invasive mechanical ventilation in a critical coronary care unit

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
DF Arroyo Monino ◽  
M Rivadeneira Ruiz ◽  
MP Ruiz Garcia ◽  
T Seoane Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Cardiac Arrest ◽  
Coronary Care Unit ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Older Age ◽  
P Value ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Coronary Care ◽  
Frequent Reason

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In the recent years, we have assisted to a change of the prototype of the patient admitted to a Critical Coronary Care Unit (CCCU), with an increasing number of patients admitted due to acute heart failure (AHF) and the reduction of the patients diagnosed of acute coronary syndrome (ACS). It is common in these patients the requirement of ventilatory support, both invasive (IMV) and non-invasive. As a consequence, our knowledge about this technique must be improved. A critical moment when using IMV is the weaning of the IMV. Objective Our aim is to describe which factors may have an influence on the success or the failure of the weaning of IMV. Methods Observational, retrospective study, using a cohort of patients admitted to a CCCU between January 2.018 and November 2.020 who needed IMV. Data related with the personal history, basal situation and events in the follow-up during the hospitalization were collected. Results A total number of 94 patients were included, being 68 (72,3%) male and with a mean age of 68 years old. The most frequent reason of intubation was cardiac arrest (48 patients – 51,1%). Failure on weaning occurred in 19 patients (20,2%), being the most frequent reason of this failure need of re-intubation due to respiratory failure or a new event of cardiac arrest (14 patients – 14,9%). When assessing which factors could have an impact in this failure, we found that older age (66,6 years old vs. 73,9 years old, p value = 0,035), the previous diagnosis of chronic obstructive pulmonary disease (COPD) (17,1% vs. 28,5%, p value = 0,01), and the develop of sepsis during the hospitalization (45,7% vs. 57%, p value =0,04), determined a significative higher probability of failing in the weaning. As expected, failure in the weaning conditioned a significative longer stay in the CCCU (9 days vs. 22 days; p value <0,001). However, failure in the weaning was not related with a higher intra-hospital mortality in our study (p value 0,6). Conclusion In our population, the older age, the presence of COPD and the development of sepsis during the stay in the CCCU were related with a significative higher probability of failure in the weaning of IMV. This conditioned a longer stay in the CCCU but not a higher intra-hospitalary mortality.

scholarly journals Characteristics and outcomes in acute patients receiving mechanical ventilation in a Coronary Care Unit (CCU)

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Rivadeneira Ruiz ◽  
DF Arroyo Monino ◽  
T Seoane Garcia ◽  
MP Ruiz Garcia ◽  
JC Garcia Rubira
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Care Unit ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Funding Sources ◽  
Copd Patients ◽  
The Mean ◽  
Coronary Care

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Mechanical ventilation is the short-term technical support most widely used and cardiac arrest its main indication in a Coronary Care Unit (CCU). However, the knowledge about the specific moment and ventilator mode of onset to avoid the acute lung injury is still equivocal. Our objective is to determine the survival rate and the prognostic factors in patients supported by mechanical ventilation. Methods We conducted a retrospective cohort study of adult patients admitted to the CCU between January 2018 and November 2020 that received mechanical ventilation during the hospital stay. Results We collected 94 patients, 28% females with a median age of 68 ± 11,9. 43% were diabetics and almost one quarter of them had some degree of chronic obstructive pulmonary disease (COPD). Ischemic cardiopathy (33%) and heart failure (31%) were frequent pathologies as well as renal injury (29% patients a filtration rate below 45 mL/min/1,73m2). The reason for initiating mechanical ventilation was cardiac arrest in the half of the patients. Volume-controlled ventilation (73%) was the initial setting mode in most cases. The support with vasoactive drugs were highly necessary in these patients (Infection rate of 48%). In the subgroup analysis, we realized that the number of reintubations and the necessity of non-invasive ventilation were higher in the COPD group (p = 0,01), as well as tracheostomy (p = 0,03). COPD patients also needed higher maintaining PEEP, though this was not statistically significant. The mean length of stay in the intensive care unit of our cohort was 11 days (range: 1-78 days; median: 8 days) and the mean length of mechanical ventilation 6 days (range: 1-64 days; median: 3 days). The in-hospital mortality was 41,4%. Conclusions Cardiac arrest is the most common reason of mechanical ventilation support. Our study showed that COPD patients presented more complications during the weaning and the period after extubation. In-hospital mortality remains high in intubated patients.

The Reduction of Cardiac Patients in the Coronary Care Unit of the Santa Izabel Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 4 (3/4) ◽  
pp. 131-134
Author(s):  
Gilson Feitosa ◽  
Leandro Cavalcanti ◽  
Amanda Fraga ◽  
Milana Prado ◽  
Gilson Feitosa Filho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Angina Pectoris ◽  
Coronary Care Unit ◽  
Myocardial Revascularization ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
The World ◽  
St Elevation ◽  
Coronary Care

The coronary care unit by Santa Izabel Hospital (Salvador, Bahia, Brazil) made a comparison of admitted patients with coronary disease cases admitted between two equivalent periods ranging from April through July in 2019 and 2020. There was a striking reduction in 2020 of cases of ST-elevation myocardial infarction (39%); non-ST elevation myocardial infarction (19%); and unstable angina pectoris (21%). This occurred in parallel with what happened in many parts of the world and hampered offering the best treatment strategy to these patients with an acute coronary syndrome such as invasive stratification and myocardial revascularization.  

P6471Pronostic impact of significant valvular disease in long-term survivors of out-of-hospital-cardiac arrest

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rodriguez ◽  
J Caro-Codon ◽  
J R Rey-Blas ◽  
S O Rosillo ◽  
O Gonzalez ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Percutaneous Treatment ◽  
Valvular Disease ◽  
Temperature Management ◽  
P Value ◽  
Coronary Syndrome ◽  
Hospital Cardiac Arrest

Abstract Background There is scarce evidence about the prevalence and clinical relevance of moderate to severe valvular heart disease (VHD) in survivors of out of hospital cardiac arrest (OHCA). Purpose To determine whether VHD influence prognosis of OHCA survivors. Methods All consecutive patients admitted to the Acute Cardiac Care Unit after OHCA and surviving until hospital discharge were included. All patients received targeted-temperature management according to our local protocol. Univariate and multivariate Cox-proportional hazard models were employed. Results A total of 201 patients were included in the analysis. Mean age was 57.6±14.2 years and 168 (83.6%) were male. Eighteen patients (9.0%) had moderate or severe VHD during index admission (Table 1). Patients with VHD were less frequently of male sex, [11 (61.1%) vs 157 (85.8%), p=0.014], experienced less acute coronary syndrome-related arrhytmias [2 (11.1%) vs 85 (46.5%), p=0.005], and had a lower pH at hospital admission (6.9±1.6 vs 7.2±0.15, p=0.008). During a median follow-up of 40.3 (18.9–69.1) months, patients with VHD showed higher mortality [7 (38.9%) vs 28 (15.3%), p=0.004] and more heart failure-related admissions [7 (38.9%) vs 15 (8.2%), p<0.001]. Only five patients received surgical or percutaneous treatment for VHD during follow-up, with no deaths in this subgroup. Moderate or severe VHD proved to be an independent predictor of global cardiovascular events and specifically heart failure episodes (Figure 1). Table1 Variable With valvular disease Without valvular disease p value Age, mean±DS, years 63.5±13.2 57.0±14.1 0.066 Hypertension, n (%) 12 (66.7) 95 (51.9) 0.231 Diabetes, n (%) 5 (27.8) 24 (13.1) 0.149 Dyslipidaemia, n (%) 7 (38.9) 79 (43.2) 0.726 Smokin habit, n (%) 4 (22.2) 90 (49.2) 0.045 Witnessed cardiac arrest, n (%) 18 (100) 175 (95.6) 1.000 Time from CA to ROSC, mean±DS, minute 19.1±7.5 21.2±13.1 0.506 Shockable rhythm, n (%) 13 (72.2) 163 (89.1) 0.055 LVEF at hospital discharge (%) 42.8±12.1 46.9±14.6 0.254 Figure 1 Conclusion The presence of significant VHD in survivors after OHCA is a predictor of poor outcomes. Specific management of VHD may be specially relevant in this high-risk patients and guideline-oriented therapy, including surgery and percutaneous intervention should be encouraged when indicated.

scholarly journals Impact of Age on Risk Factors and Clinical Manifestations of Acute Coronary Syndrome: Observations From the Coronary Care Unit of Sulaimani, Iraq

2020 ◽  
Vol 5 (1) ◽  
pp. 28-34
Author(s):  
Amanj Abubakr Jalal Khaznadar ◽  
Rebin Wahid Salh
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Physical Inactivity ◽  
Coronary Care Unit ◽  
St Segment Elevation ◽  
Atypical Symptoms ◽  
Coronary Syndrome ◽  
St Segment ◽  
Coronary Care

Background: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI ) are common types of acute coronary syndrome which are associated with the risk factors of age, obesity, hypertension, and diabetes. Objective: The present study aimed to examine the effects of age on the risk factors and clinical symptoms of acute coronary syndrome. Methods: A cross-section prospective study was conducted on 125 patients with acute coronary syndrome chosen by non-probability convenience sampling method in the coronary care unit in Sulaimani, the Kurdistan region of Iraq. Acute coronary syndrome types were diagnosed through clinical presentations, electrocardiography (ECG), and troponin test. Data was collected using a researcherbased checklist through face-to-face interviews. Results: The results indicated that males were the dominant group. The age group 45-65 had the highest prevalence rate of acute coronary syndrome. The most frequent risk factors for acute coronary syndrome were hypertension (54.4%), dyslipidemia (52%), smoking (42.4%), and diabetes mellitus (38.4%). Typical chest pain was found to be the most frequent clinical presentation (88%). There was a significant difference between the age groups in terms of the effect of age on typical and atypical symptoms; however, neither age nor typical/atypical symptoms had a significant effect on type of acute coronary syndrome. Similarly, family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia had no effect on type of acute coronary syndrome. Conclusion: Age is a predictive factor for acute coronary syndrome, but family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia cannot predict acute coronary syndrome.

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