Effects of Atrial Fibrillation on Intensive Care Unit Outcomes in Patients with Respiratory Failure/Atrial Fibrilasyonun Solunum Yetmezligi Hastalarinin Yogun Bakim Sonuclarina Etkisi

• Published in: Yogu︣n bakim dergisi Vol. 8; no. 2; p. 32
• Main Authors: Aydogdu, Muge, Hanazay, Cigdem, Aldag, Yagmur, Baha, Ayse, Bilgin, Salih, Gursel, Gul
• Format: Journal Article
• Language: English
• Published: AVES 01-08-2017
• Subjects: Analysis; Atrial fibrillation; Care and treatment; Diagnosis; Intensive care units; Management; Mortality; Patient outcomes; Respiratory insufficiency; Risk factors
• ISSN: 1309-1689
• DOI: 10.5152/dcbybd.2017.1482

Objective: A negative impact of atrial fibrillation (AF) on clinical outcomes has been well defined in surgical intensive care unit (ICU) patients. However, some questions remain unanswered regarding the relationship between AF and ICU outcomes in patients with respiratory failure (RF). This study aims to determine the incidence of AF and its effects on ICU outcome among RF patients. In addition, the effects of bronchodilators on AF control, and cardiac medications on RF control, were also assessed. Material and Methods: In this retrospective observational cohort study, electrocardiographs of all included RF patients were evaluated for AF Patients were divided into two groups both for AF and mortality, and they were compared for demographics, diagnosis, comorbidities, risk factors, ICU outcomes, and cardiac and bronchodilator therapies. Results: A 25% incidence of AF was found in a cohort of 147 patients (mean age 68 [+ or -] 15years), and among them, 3% was newly diagnosed. There was no significant difference between the groups with respect to demographics, diagnoses, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores of both groups. The incidence of heart failure and cerebrovascular event was found to be higher in patients with AF (p<0.05). There was no significant difference in sepsis, duration of mechanical ventilation, and ICU stay, but mortality and acute kidney injury were more common in AF patients (36% vs. 21% and 44% vs. 15% respectively, p<0.05). The mortality risk increased 3 times with AF [OR(%95CI):3.09(0.91--10.3)]. There were no significant effects of bronchodilators on AF control and cardiac medications on RF control detected. Conclusion: AF should be diagnosed and treated appropriately in RF patients. Bronchodilator and cardiac medications should not be avoided or withheld when indicated to prevent negative ICU outcomes. Keywords: Atrial fibrillation, respiratory failure, intensive care unit, mortality, outcome Received: 08.05.2017 Accepted: 27.11.2017 Amac: Atrial fibrilasyon (AF) ve klinik sonuclar arasindaki olumsuz iliski cerrahi yogun bakim unitesi (YBU) hastalarinda iyi tanimlanmistir. Ama ozellikle solunum yetmezligi hastalarinda eslik eden AF'nin prognoza etkileri henuz kesinlik kazanmamistir. Bu calismada amac solunum yetmezligi ile izlenen YBU hastalarinda AF insidansini belirlemek ve AF varliginin YBU sonuclarina etkisini degerlendirmektir. Ek olarak solunum yetmezliginde kullanilan bronkodilator tedavilerin AF kontrolune; AF kontrolunde kullanilan kardiyak tedavilerin de solunum sistemine etkileri arastirilmistir. Gerec ve Yontemler: Bu retrospektif, gozlemsel kohort calismasinda solunum yetmezligi ile YBU'ye yatan tum hastalarin elektrokardiyografileri AF varligi acisindan degerlendirilmistir. Hastalar AF ve mortaliteye gore gruplandirilmis ve demografik ozellikleri, tanilari, komorbiditeleri, risk faktorleri, kardiak ve bronkodilator tedavileri ve YBU sonuclari acisindan karsilastirilmislardir. Bulgular: Yas ortalamalari 68 [+ or -] 15 yil olan, 147 hastalik calisma kohortunda %25 AF insidansi saptanmistir; bunlarin sadece %3'une yeni AF tanisi konmustur. AF'si olan ve olmayan hasta gruplarinin demografik verileri, yatis tanilari ve APACHE II skorlari arasinda anlamli farklilik saptanmamistir. Kalp yetmezligi ve serebrovaskuler olay AF (+) hasta grubunda anlamli derecede yuksek bulunmustur (p<0.05). Yogun bakim sonuclari acisindan degerlendirildiginde iki grup arasinda sepsis,mekanik ventilasyon ve YBU yatis suresi acisindan anlamli farklilik saptanmazken mortalite ve akut bobrek hasari AF (+) hasta grubunda anlamli derecede yuksek bulunmustur (sirasiyla %36 vs. %21 and %44 vs.%15, p<0,05). Yapilan regresyon analizinde diger faktorlerin yani sira,AF varliginin mortalite riskini 3 kat artirdigi belirlenmistir [0R(%95CI):3,09(0,91-10,3)].llaclar degerlendirildiginde bronkodilatorlerin AF kontrolu uzerine ve kardiak tedavilerin solunum yetmezligi uzerine olumsuz etkileri saptanmamistir. Sonuc: Atrial fibrilasyon solunum yetmezligi ile YBU'lerde izlenen hastalarda mortaliteyi olumsuz etkilemesi nedeniyle dikkatle taninmali ve tedavi edilmelidir. Bu hastalarin tedavisinde bronkodilator ve kardiak ilaclarin kullanimindan kacinilmamalidir. Anahtar kelimeler: Atriyal fibrilasyon, solunum yetmezligi, yogun bakim unitesi, mortalite, Sonuclar Gelis Tarihi: 08.05.2017 Kabul Tarihi: 27.11.2017