Bauchmuller Kris, Condliffe Robin, Southern Jennifer, Billings Catherine, Charalampopoulos Athanasios, Elliot Charlie A, Hameed Abdul, Kiely David G, Sabroe Ian, Thompson A A Roger, Raithatha Ajay, Mills Gary H
Dept of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
These authors contributed equally.
ERJ Open Res. 2021 Apr 6;7(2). doi: 10.1183/23120541.00046-2021. eCollection 2021 Apr.
Pulmonary hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce. We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000-2017 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer term outcomes in survivors to hospital discharge. 242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons, respectively. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II (Acute Physiology and Chronic Health Evaluation) score, age and lactate, and lower oxygen saturation measure by pulse oximetry/inspiratory oxygen fraction ( / ) ratio, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (oxygen ( / ) ≤185; platelets ≤196×10·L; age ≥37.5 years; lactate ≥2.45 mmol·L; sodium ≤130.5 mmol·L), identified medical patients at increasing risk of hospital mortality. One (11%) out of nine patients who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge. These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.
肺动脉高压（PH）是一种会缩短寿命的疾病，其特征是由疾病进展、心律失常和败血症等因素引发失代偿发作。手术和妊娠也会给右心室带来额外负担。关于已有肺动脉高压患者的重症监护管理的数据很少。我们对2000年至2017年间入住一家国家转诊中心重症监护病房的一大群患者进行了一项回顾性观察研究，以确定急性死亡率，评估住院死亡率的预测因素，并确定存活至出院患者的长期预后。共识别出涉及206名患者的242次重症监护入院病例。因医疗、手术或产科原因入院的患者，其医院生存率分别为59.3%、94%和92%。与接受手术或产科干预后入院的患者相比，内科患者有更严重的生理和实验室紊乱情况。较高的急性生理与慢性健康状况评估（APACHE II）评分、年龄和乳酸水平，以及较低的脉搏血氧饱和度/吸入氧分数（ / ）比值、血小板计数和钠水平被确定为住院死亡率的独立预测因素。一个探索性风险评分，即OPALS（氧（ / ）≤185；血小板≤196×10⁹/L；年龄≥37.5岁；乳酸≥2.45 mmol/L；钠≤130.5 mmol/L），识别出医院死亡率风险增加的内科患者。因医疗失代偿接受有创通气的9名患者中有1名（11%）存活出院，接受肾脏替代治疗的患者中有50%存活出院。存活至出院的患者在随访时与入院前相比，运动能力或功能分级没有显著差异。这些数据在指导已知肺动脉高压患者的重症监护管理方面具有临床实用性。探索性OPALS评分需要验证。
