Management Patterns and Outcomes of Invasive Mechanical Ventilation in Patients With Cardiogenic Shock

JACC advances Pub Date : 2025-10-01 DOI:10.1016/j.jacadv.2025.101916

Christopher S. Grubb MD , Grant Tucker BS , Neda Bionghi MD , Catherine Chen MD, MSHI , Bethany L. Lussier MD , Corey D. Kershaw MD , Gregory Ratti MD , Roma Mehta MD , Colby R. Ayers MS , Nicholas S. Hendren MD , Justin L. Grodin MD, MPH , Jennifer T. Thibodeau MD, MSCS , Ann Marie Navar MD, PhD , Maryjane A. Farr MD, MSc , Sandeep R. Das MD, MPH , James A. de Lemos MD , Eric J. Hall MD

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Abstract

Background

Approximately one-half of patients with cardiogenic shock (CS) require invasive mechanical ventilation (IMV). Much of the data regarding IMV management is extrapolated from other populations, and little is known regarding management and outcomes of patients with CS who require IMV.

Objectives

This study aims to provide data on IMV management in a CS-specific cohort.

Methods

Retrospective study of 104 patients treated for CS requiring IMV at an academic safety net hospital from 2017 to 2023. Indications for IMV, ventilator settings, and medications were obtained. Outcomes included in-hospital mortality, survival to extubation, and reintubation.

Results

Reasons for intubation included ongoing cardiac arrest (37%) and hypoxic respiratory failure (32%). Most were on low-level ventilator support 24 hours after intubation (median fraction of inspired oxygen 40% [IQR: 30%-50%], positive end-expiratory pressure 5 cm H₂O [IQR: 5-8]). Spontaneous breathing trials were delayed in 78%, primarily due to hemodynamic instability (82%). Nonpalliative extubation occurred in 62% after a median of 4.8 days (IQR: 2.3-8.0). Among patients who received temporary mechanical circulatory support (tMCS) (49%) and survived, tMCS was removed before extubation in 98%. Reintubation occurred in 14% within 48 hours, and in-hospital mortality was 41%.

Conclusions

In this cohort, patients were frequently on minimal ventilator support within 24 hours of intubation, yet spontaneous breathing trials and extubation were delayed due to hemodynamic instability. Rates of failed extubation were comparable to other forms of critical illness. Further research is necessary to determine optimal approaches to ventilator liberation in patients with CS, particularly when hemodynamic derangements or tMCS persist in patients who are otherwise candidates for extubation.

查看原文本刊更多论文

心源性休克患者有创机械通气的处理模式和结果。

背景：大约一半的心源性休克（CS）患者需要有创机械通气（IMV）。许多关于IMV管理的数据是从其他人群中推断出来的，对于需要IMV的CS患者的管理和结果知之甚少。目的：本研究旨在为cs特异性队列的IMV管理提供数据。方法：回顾性研究2017 - 2023年某学术安全网医院收治的104例需要IMV治疗的CS患者。获得了IMV的适应症、呼吸机设置和药物。结果包括住院死亡率、拔管存活率和再插管存活率。结果：插管的原因包括持续的心脏骤停（37%）和缺氧呼吸衰竭（32%）。大多数患者在插管后24小时使用低水平呼吸机支持（吸入氧中位数40% [IQR: 30%-50%]，呼气末正压5 cm H2O [IQR: 5-8]）。自发呼吸试验延迟78%，主要是由于血流动力学不稳定（82%）。62%的患者在中位4.8天（IQR: 2.3-8.0）后拔管。在接受临时机械循环支持（tMCS）并存活的患者中（49%），98%的患者在拔管前移除tMCS。在48小时内再次插管的发生率为14%，住院死亡率为41%。结论：在本队列中，患者经常在插管后24小时内使用最低限度的呼吸机支持，但由于血流动力学不稳定，自发呼吸试验和拔管延迟。拔管失败的比率与其他形式的危重疾病相当。需要进一步的研究来确定CS患者解除呼吸机的最佳方法，特别是当血流动力学紊乱或tMCS持续存在时，否则可能需要拔管。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC advances Cardiology and Cardiovascular Medicine

CiteScore

1.90

自引率

0.00%

发文量