Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine, UCLA, BOX 951690, 37-131 CHS, Los Angeles, CA 90095-1690, USA.
J Crit Care. 2012 Dec;27(6):739.e7-13. doi: 10.1016/j.jcrc.2012.08.006. Epub 2012 Oct 22.
Patients with pulmonary hypertension (PH) can decompensate to the point where they require care in the intensive care unit (ICU). Our objective is to examine the outcomes and characteristics of patients with PH admitted to the ICU.
This is a retrospective study of 99 patients with PH who were admitted to the medical ICU of a single tertiary care center. Baseline characteristics, interventions during ICU admission, and ICU and 6-month outcome were documented. Univariate and multivariate logistic regressions were used to evaluate association of patient characteristics with mortality.
Intensive care unit mortality was 30%, and 6-month mortality was 40%. Acute Physiology and Chronic Health Evaluation II score, World Health Organization Group 3 PH, and preexisting treatment with a prostacyclin at time of ICU admission were associated with worse outcome. Patients who received cardiopulmonary resuscitation had 100% mortality. The requirement for mechanical ventilation and dialysis was also associated with increased mortality. Pulmonary artery catheter placement was associated with reduced mortality, specifically if it was placed early during ICU admission and if associated with a change in the present management.
Mortality is high in critically ill patients with PH. The identification of prognostic baseline characteristics and interventions in the ICU is important and warrants further investigation.
患有肺动脉高压（PH）的患者可能会失代偿到需要在重症监护病房（ICU）接受治疗的程度。我们的目的是研究入住 ICU 的 PH 患者的结局和特征。
这是一项对单中心三级保健中心的内科 ICU 收治的 99 例 PH 患者进行的回顾性研究。记录了患者的基本特征、入住 ICU 期间的干预措施以及 ICU 和 6 个月的结局。采用单因素和多因素逻辑回归分析评估患者特征与死亡率的相关性。
ICU 死亡率为 30%，6 个月死亡率为 40%。急性生理学和慢性健康评估 II 评分、世界卫生组织第 3 组 PH 和入住 ICU 时已存在前列环素治疗与较差的结局相关。接受心肺复苏的患者死亡率为 100%。需要机械通气和透析也与死亡率增加相关。肺动脉导管放置与死亡率降低相关，尤其是在 ICU 入住期间早期放置且与当前治疗方案的改变相关时。
危重症 PH 患者死亡率较高。识别 ICU 中的预后基线特征和干预措施非常重要，值得进一步研究。
