Published online Jun 5, 2020. doi: 10.5492/wjccm.v9.i2.20
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
Hypotension is a frequent complication in the intensive care unit (ICU) after adult cardiac surgery.
To describe frequency of hypotension in the ICU following adult cardiac surgery and its relation to the hospital outcomes.
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.
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).
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.