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

Area of Science:

• Critical Care Medicine
• Cardiology
• Respiratory Therapy

Background:

• Cardiogenic shock (CS) frequently necessitates invasive mechanical ventilation (IMV), yet specific management data is limited.
• Existing knowledge on IMV is often extrapolated from other patient groups, highlighting a gap in CS-specific evidence.

Purpose of the Study:

• To investigate the management and outcomes of invasive mechanical ventilation in a cohort of patients with cardiogenic shock.
• To provide data-driven insights into ventilator settings, liberation strategies, and associated mortality in CS patients requiring IMV.

Main Methods:

• Retrospective analysis of 104 patients with CS requiring IMV from 2017-2023.
• Data collection included indications for IMV, ventilator parameters, medications, and patient outcomes.
• Key outcomes assessed were in-hospital mortality, survival to extubation, and reintubation rates.

Main Results:

• Common intubation reasons were cardiac arrest (37%) and hypoxic respiratory failure (32%).
• Most patients received low-level support within 24 hours, but spontaneous breathing trials were delayed in 78% due to hemodynamic instability.
• Non-palliative extubation occurred in 62% after a median of 4.8 days, with a 14% reintubation rate and 41% in-hospital mortality.

Conclusions:

• CS patients on IMV often achieve minimal ventilator support quickly, but hemodynamic instability delays liberation.
• Extubation failure rates were similar to other critical illness populations.
• Optimal ventilator liberation strategies require further investigation, especially for patients with persistent hemodynamic issues or on temporary mechanical circulatory support (tMCS).