Abstract Mechanical ventilation is a frequently used tool in the Acute/Intensive Cardiac Care Unit (ICCU). Out-of-hospital cardiac arrest (OHCA) and cardiogenic shock (CS) are two of the most usual causes for orotracheal intubation (OIT) and invasive mechanical ventilation (IVM) in these units. The main objective of this work was analysing the features of the patients needed of invasive mechanical ventilation, describing the most usual indications for this technique and evaluating the prognosis of these patients. 100 consecutive patients admitted to the CCU between 2021 and 2024 with availability of invasive mechanical ventilation related data (ventilation mode, pressures, respiratory rate, gas exchange values, sedative drugs, duration of mechanical ventilation…) were included. Most frequent causes for OIT and IMV were CS (38%), followed by OHCA (25%) and acute pulmonary edema (APE) (19%). IMV median duration was 48h 24-96h. This was significantly shorter in patients with APE in relation to patients with OHCA or CS (p=0.017). CS patients required higher FiO2 values at admission (p=0.03). 27% of patients passed away during this therapy. The remaining 73% was extubated. The highest success rate in extubation was observed in the group of patients with APE, followed by the CS one (p=0.024). Death rate along the admission and during IMV was greater in the OHCA group (p=0.004 and p=0.024, respectively). Mortality was higher in the CS group during follow-up (p=0.04). Past smoking habit (HR= 2,13; IC 95% 1,02-4,48; p=0,044), respiratory rate (HR= 1,24; IC 95% 1,06-1,44; p=0,006), initial lactate levels (HR= 1,09; IC 95% 1,02-1,16; p=0,006), lactate levels before extubation (HR= 1,33; IC 95% 1,19-1,50; p0,001) and after extubation (HR= 2,31; IC 95% 1,07-4,99; p=0,033), and OHCA as cause for intubation (HR=2,09; IC 95% 1,04-4,19; p=0,037) showed a significant association with in-hospital mortality. FiO2 initially required showed a near significant association (HR=8,81; IC 95% 0,99-67,71; p=0,051). Pre-extubation pH (HR= 0,0023; IC 95% 0,0001-0,05; p0,001) and pre-extubation HCO3 (HR= 0,92; IC 95% 0,87-0,97; p=0,002) showed a significant association to a protective role. Multivariable cox regression analysis showed that OHCA as cause for intubation (HR 9,83; IC 1,66-58,17; p=0,012) and lactate levels after extubation (HR= 3,31; IC 95% 1,35-8,08; p=0,012) were in-hospital mortality predictors. Results: obtained from this work are in line with previous evidence. Lactate levels are classic prognosis predictors in critical illness. In addition, it is also known the bad prognosis of patients with OHCA (10%). Something to remark is that mortality rate during IMV and the admission was notoriously lower than the showed in other similar recent studies. In relation to this, it is also noticeable that the mortality rate in the group of CSwas lower than what is usually described in the literature and the excellent prognosis of patients with APE.
Cervera et al. (Fri,) studied this question.