J Korean Soc Emerg Med.  2000 Dec;11(4):539-545.

The Importance of Initial Mechanical Ventilation Mode in Acute Respiratory Failure: Risk Factors for the Development of Cardiac Arrhythmias

• Lee YJ
• Kim W
• Kim YD
• Cheon SC
• Lim KS

Abstract

BACKGROUND: The purpose of this article was to identify the risk factors related to development of hemodynamically significant cardiac arrythmias in patients with mechanical ventilation.
METHODS AND RESULTS
Holter recording and echocardiogram were performed after 30 minutes of ventilator initiation in patients on mechanical ventilation(MV) owing to respiratory failure(RF) from various reasons. From 68 patients, hemodynamically significant cardiac arrythmias 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 arrythmias. Additionally, the patients with pressure-controlled ventilation as an initial ventilatory mode developed hemodynamically significant cardiac arrythmias less frequently than the patients with other modes(15.8% vs. 40%, p=0.03). In multivariate analysis, initial mean arterial pressure(<70mmHg, odds ratio[OR]:5.5;95% confidence interval[CI]:1.2 to 24.2, p=0.026), maximal heart rate(>120/min, OR:19.7;95% CI:2.0 to 190.0, p=0.01), and pressure-controlled ventilation(OR:0.13,95% CI:0.03 to 0.55, p=0.006) were associated with the development of hemodynamically significant cardiac arrhythmias.
CONCLUSION
Theses findings suggest that during the early stages of mechanical ventilation with acute respiratory failure, hemodynamically significant cardiac arrhythmias are directly associated with tachycardia(>120/min), initial MAP(<70mmHg), and, inversely, the initial use of pressure-controlled ventilation.

MeSH Terms

Arrhythmias, Cardiac*
Arterial Pressure
Heart
Heart Rate
Humans
Hydrogen-Ion Concentration
Multivariate Analysis
Respiration, Artificial*
Respiratory Insufficiency*
Risk Factors*
Ventilation
Ventilators, Mechanical