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

Purpose:The purpose of this article was to identify the risk factors relate d to development of hemodynamically significant cardiac arrhythmias in pati ents with mechanical ventilation. Materials and Methods: Holter recording and echocardiogram were performed w ithin 24 hours of ventilator initiation in patients on mechanical ventilati on (MV) owing to respiratory failure (RF) from various reasons. Results: From 68 patients, hemodynamically significant cardiac arrhythmias were detected in 18 patients (26.5%). Initial mean arterial pressure, maxim al heart rate, and initial pH were identified as risk factors for hemodynam ically significant cardiac arrhythmias, Additionally, the patients with pre ssure-controlled ventilation as an initial ventilatory mode developed hemod ynamically significant cardiac arrhythmias less frequently than the patient s with other modes (15.8% vs. 40%, P = .03). In multivariate analysis, init ial mean arterial pressure (< 70 mm Hg, odds ratio [OR]: 5.5; 95% confidenc e 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 develop ment of hemodynamically significant cardiac arrhythmias, Conclusions: These findings suggest that during the early stages of mechani cal ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia (greater than or equal to 120/min), initial MAP (<70 mm Hg), and, inversely, the initial use of pressure-controlled ventilation. Copyright (C) 2000 by W.B. Saunder s Company.