Cengic Sabina, Zuberi Muhammad, Bansal Vikas, Ratzlaff Robert, Rodrigues Eduardo, Festic Emir
Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States.
World J Crit Care Med. 2020 Jun 5;9(2):20-30. doi: 10.5492/wjccm.v9.i2.20.
Hypotension is a frequent complication in the intensive care unit (ICU) after adult cardiac surgery.
To describe frequency of hypotension in the ICU following adult cardiac surgery and its relation to the hospital outcomes.
A retrospective study of post-cardiac adult surgical patients at a tertiary academic medical center in a two-year period. We abstracted baseline demographics, comorbidities, and all pertinent clinical variables. The primary predictor variable was the development of hypotension within the first 30 min upon arrival to the ICU from the operating room (OR). The primary outcome was hospital mortality, and other outcomes included duration of mechanical ventilation (MV) in hours, and ICU and hospital length of stay in days.
Of 417 patients, more than half (54%) experienced hypotension within 30 min upon arrival to the ICU. Presence of OR hypotension immediately prior to ICU transfer was significantly associated with ICU hypotension (odds ratio = 1.9; 95% confidence interval: 1.21-2.98; < 0.006). ICU hypotensive patients had longer MV, 5 (interquartile ranges 3, 15) 4 h (interquartile ranges 3, 6), = 0.012. The patients who received vasopressor boluses ( = 212) were more likely to experience ICU drop-off hypotension (odds ratio = 1.45, 95% confidence interval: 0.98-2.13; = 0.062), and they experienced longer MV, ICU and hospital length of stay ( < 0.001, for all).
Hypotension upon anesthesia-to-ICU drop-off is more frequent than previously reported and may be associated with adverse clinical outcomes.
低血压是成人心脏手术后重症监护病房（ICU）常见的并发症。
描述成人心脏手术后ICU中低血压的发生频率及其与医院结局的关系。
对一家三级学术医疗中心两年内心脏手术后成年患者进行回顾性研究。我们提取了基线人口统计学、合并症和所有相关临床变量。主要预测变量是从手术室（OR）进入ICU后30分钟内低血压的发生情况。主要结局是医院死亡率，其他结局包括机械通气（MV）时长（小时）、ICU住院天数和医院住院天数。
417例患者中，超过一半（54%）在进入ICU后30分钟内出现低血压。ICU转运前立即出现的OR低血压与ICU低血压显著相关（比值比=1.9；95%置信区间：1.21 - 2.98；P<0.006）。ICU低血压患者的MV时间更长，分别为5（四分位间距3，15）小时和4（四分位间距3，6）小时，P = 0.012。接受血管升压药推注的患者（n = 212）更有可能出现ICU低血压（比值比=1.45，95%置信区间：0.98 - 2.13；P = 0.062），并且他们的MV时间、ICU住院时间和医院住院时间更长（所有P<0.001）。
麻醉至ICU期间出现的低血压比先前报道的更为常见，且可能与不良临床结局相关。
