Arrhythmia Incidence and Risk Factors in Adult Critically Ill Patients in Intensive Care Unit

Öz

Introduction: Cardiac arrhythmias may be observed at critically ill patients during intensive care unit (ICU) stay, and this condition may negatively affect the prognosis. In our study, we aimed to evaluate the incidence and risk factors of arrhythmias occurring in critically ill patients being treated in the ICU. Materials and Methods: The study included critically ill patients over the age of 18, who were receiving mechanical ventilation (MV), had at least one organ failure, but had no history of valvular hearth disease, cardiac surgery within the past 6 months, or myocardial infarction (MI). Demographic, hemodynamic and laboratory parameters, acute physiology and chronic health evaluation (APACHE) II score, ICU practices and treatments (tracheostomy, central venous catheter, inotrophic and vasoactive drugs. etc), diagnoses of sepsis, AKI (acute kidney injury), MI, and ventilator-associated pneumonia (VAP) during ICU stay, duration of ICU and hospital stay, and outcome of ICU treatment were recorded. In patients who developed arrhythmia, an electrocardiography was performed. During arrhythmia episode, hemodynamic and laboratory parameters, the use of inotropic and vasoactive drug, the presence of diagnosis such as sepsis, AKI, MI and pneumonia as well as treatments applied for arrhythmia and their outcome were recorded. Results: The study included 214 patients, among whom 56 (26.1%) developed arrhythmia. Arrytmia incidence in females (55.5%) were higher than male patients (44.6%) (p=0.045). Arrhythmic patients were older (p<0.001), had higher APACHE II scores (p=0.001), and were more frequently admitted to the ICU with a diagnosis of CVE (cerebrovascular event) and trauma (p=0.021, p=0.032, respectively) compared to non-arrhythmic patients. Furthermore, a higher incidence of arrhythmia was observed in patients who developed VAP and sepsis during ICU stay (p<0.001, p<0.001 respectively). The most frequently observed type of arrhythmia was atrial fibrillation (53%). Conclusion: Older age, higher APACHE II score, CVE, trauma, VAP and sepsis increases arrhytmia risk in adult critically ill patients.

Anahtar Kelimeler

• arryhthmia
• intensive care unit
• critically ill patient
• atrial fibrillation
• ventricular tachycardia

Yoğun Bakım Ünitesinde Yetişkin Kritik Hastalarda Aritmi İnsidansı ve Risk Faktörleri

Öz

Amaç: Kritik hastalarda yoğun bakımda (YB) yatışları döneminde kardiyak aritmiler gözlenebilmekte ve bu durum prognozu olumsuz etkileyebilmektedir. Çalışmamızda YB’de tedavi edilmekte olan kritik hastalarda aritmi insidansını ve risk faktörlerini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya mekanik ventilasyon (MV) uygulanan, en az bir organ yetmezliği olan 18 yaş üzeri, kalp kapak hastalığı ve 6 ay içinde geçirilmiş kardiyak cerrahi ya da miyokard infarktüsü (MI) öyküsü bulunmayan kritik hastalar dahil edildi. Demografik, hemodinamik ve laboratuvar parametreleri, akut fizyoloji ve kronik sağlık değerlendirmesi (APACHE) II skorları, YB’deki tıbbi uygulamalar-tedaviler (trakeostomi, santral venöz kateter, inotropik ve vazoaktif ilaç vs.), YB tedavi döneminde gelişen tanılar (sepsis, AKI: akut böbrek hasarı, MI ve ventilatörle ilişkili pnömoni: VAP), YB ve hastanede yatış süreleri ile YB tedavi sonucu kayıt edildi. Kardiyak aritmi gelişen hastalardan aritmi sırasında EKG çekildi. Aritmi geliştiği andaki hemodinamik parametreler, laboratuar verileri, inotropik ve vazoaktif ilaç kullanımları, sepsis, ARY, MI ve pnömoni tanılarının varlığı, aritmi için uygulanan tedaviler ve sonuçları kayıt edildi. Bulgular: Çalışmaya 214 hasta dahil edildi. Hastaların 56'sında (%26,1) aritmi gelişti. Kadınlarda aritmi insidansı (%55.4), erkeklerden (%44.6) yüksekti (p=0.045). Aritmili hastalar, olmayanlara göre daha yaşlı (p<0,001), APACHE II skorları daha yüksek (p=0,001), serebrovasküler olay (SVO) (p=0,021) ve travma (p=0,032) tanısı ile YB yatış daha fazla idi. Ayrıca YB’de tedavi sırasında VAP (p<0,001) ve sepsis gelişenlerde (p<0,001) daha fazla aritmi saptanmıştı. Atriyal fibrilasyon en sık görülen aritmi türüydü (%53). Sonuç: İleri yaş, yüksek APACHE II skoru, SVO, travma, VAP ve sepsis erişkin kritik hastalarda aritmi riskini artırmaktadır.

Anahtar Kelimeler

• Aritmi
• yoğun bakım ünitesi
• kritik hasta
• atriyal fibrilasyon
• ventiküler taşikardi

Kaynakça

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