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. 2020 Jun 5;9(2):20-30.
doi: 10.5492/wjccm.v9.i2.20.

Hypotension after intensive care unit drop-off in adult cardiac surgery patients

Sabina Cengic  1 , Muhammad Zuberi  1 , Vikas Bansal  1 , Robert Ratzlaff  1 , Eduardo Rodrigues  2 , Emir Festic  3
Affiliations

Hypotension after intensive care unit drop-off in adult cardiac surgery patients

Sabina Cengic et al. World J Crit Care Med. .

Abstract

Background: Hypotension is a frequent complication in the intensive care unit (ICU) after adult cardiac surgery.

Aim: To describe frequency of hypotension in the ICU following adult cardiac surgery and its relation to the hospital outcomes.

Methods: A retrospective study of post-cardiac adult surgical patients at a tertiary academic medical center in a two-year period. We abstracted baseline demographics, comorbidities, and all pertinent clinical variables. The primary predictor variable was the development of hypotension within the first 30 min upon arrival to the ICU from the operating room (OR). The primary outcome was hospital mortality, and other outcomes included duration of mechanical ventilation (MV) in hours, and ICU and hospital length of stay in days.

Results: Of 417 patients, more than half (54%) experienced hypotension within 30 min upon arrival to the ICU. Presence of OR hypotension immediately prior to ICU transfer was significantly associated with ICU hypotension (odds ratio = 1.9; 95% confidence interval: 1.21-2.98; P < 0.006). ICU hypotensive patients had longer MV, 5 (interquartile ranges 3, 15) vs 4 h (interquartile ranges 3, 6), P = 0.012. The patients who received vasopressor boluses (n = 212) were more likely to experience ICU drop-off hypotension (odds ratio = 1.45, 95% confidence interval: 0.98-2.13; P = 0.062), and they experienced longer MV, ICU and hospital length of stay (P < 0.001, for all).

Conclusion: Hypotension upon anesthesia-to-ICU drop-off is more frequent than previously reported and may be associated with adverse clinical outcomes.

Keywords: Cardiac surgery; Care transfer; Drop-off; Hypotension; Intensive care; Postoperative care.

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Figures

Figure 1
Figure 1
Schematic representation of the study population. ICU: Intensive care unit.
Figure 2
Figure 2
Intensive care unit and operating room hypotension frequency. ICU: Intensive care unit; OR: Operating room.
Figure 3
Figure 3
Number of patients receiving the vasopressor bolus on transfer. ICU: Intensive care unit; OR: Operating room.
See this image and copyright information in PMC

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