Risk factors for the development of hemodynamically significant cardiac arrhythmias in patients with mechanical...

The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrhythmias in patients with mechanical ventilation.

Holter recording and echocardiogram were performed within 24 hours of ventilator initiation in patients on mechanical ventilation (MV) owing to respiratory failure (RF) from various reasons.

From 68 patients, hemodynamically significant cardiac arrhythmias were detected in 18 patients (26.5%). Initial mean arterial pressure, maximal heart rate, and initial pH were identified as risk factors for hemodynamically significant cardiac arrhythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrhythmias less frequently than the patients with other modes (15.8% vs. 40%, P = .03). In multivariate analysis, initial mean arterial pressure (< 70 mm Hg, odds ratio [OR]: 5.5; 95% confidence interval [CI]: 1.2 to 24.2, P = .026), maximal heart rate (> 120/min, OR: 19.7; 95% CI: 2.0 to 190.9, P = .01), and pressure-controlled ventilation (OR: 0.13; 95% CI: 0.03 to 0.55, P = .006) were associated with the development of hemodynamically significant cardiac arrhythmias.

These findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia (> or = 120/min), initial MAP (<70 mm Hg), and, inversely, the initial use of pressure-controlled ventilation.