Cengic S, Zuberi M, Bansal V, Ratzlaff R, Rodrigues E, Festic E. Hypotension after intensive care unit drop-off in adult cardiac surgery patients. World J Crit Care Med 2020; 9(2): 20-30 [PMID: 32577413 DOI: 10.5492/wjccm.v9.i2.20]
Corresponding Author of This Article
Emir Festic, MD, MSc, Full Professor, Consultant, Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States. festic.emir@mayo.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jun 5, 2020; 9(2): 20-30 Published online Jun 5, 2020. doi: 10.5492/wjccm.v9.i2.20
Hypotension after intensive care unit drop-off in adult cardiac surgery patients
Sabina Cengic, Muhammad Zuberi, Vikas Bansal, Robert Ratzlaff, Eduardo Rodrigues, Emir Festic
Sabina Cengic, Muhammad Zuberi, Vikas Bansal, Robert Ratzlaff, Emir Festic, Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
Sabina Cengic, Department of General Surgery, Stadtspital Triemli, Zurich 8063, Switzerland
Robert Ratzlaff, Eduardo Rodrigues, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, United States
Author contributions: Cengic S, Zuberi M, Bansal V and Festic E contributed to study conception and design; Cengic S, Bansal V, Rodrigues E and Festic E contributed to data acquisition, data analysis and interpretation; Cengic S and Festic E contributed to writing of article and final approval of article; Cengic S, Rodrigues E, Ratzlaff R and Festic E contributed to editing and reviewing of article.
Institutional review board statement: This study was reviewed and approved by the Mayo Clinic Institution Review Board.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The Authors declare that there is no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emir Festic, MD, MSc, Full Professor, Consultant, Department of Critical Care Medicine, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224, United States. festic.emir@mayo.edu
Received: December 22, 2019 Peer-review started: December 26, 2019 First decision: April 9, 2020 Revised: May 8, 2020 Accepted: May 14, 2020 Article in press: May 14, 2020 Published online: June 5, 2020 Processing time: 162 Days and 4.1 Hours
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.
Core tip: Hypotension is a frequent complication in adult cardiac surgery patients upon intensive care unit admission. This complication has been anecdotally called “anesthesia drop-off syndrome” and we decided to study this retrospectively. Our results suggest that this complication is more frequent than previously reported and that it may be associated with adverse outcomes.
