Mortality, Baseline Inflammatory Status and Cardiovascular Function in Adult Mechanically Ventilated, ICU Patients

Inflammation may induce cardiovascular dysfunction, prolong mechanical ventilation and contribute to weaning failure and mortality in critically ill adults. A comparison of baseline status in patients requiring mechanical ventilation who survive with those who die may contribute to understanding of factors that increase mortality. The purpose of this descriptive, comparative, repeated measures study was to compare baseline demographic, clinical, inflammatory and cardiovascular variables measured in adult ICU patients receiving mechanical ventilation who survive with those who die. Demographic and clinical data were abstracted from the medical record. Cardiovascular variables were measured using impedance cardiography. Venous blood was obtained for measurement of C- reactive protein and inflammatory cytokines. Patients (n = 38) were primarily male (57%), married (54%), Caucasians (95%) with an average age of 53 + 16 years. Patients were ventilated for 12 + 7 days, primarily for a respiratory diagnosis (62%). One third of patients (32%) died and those who died exhibited twice the comorbidity burden (p = 0.02); higher central venous pressure (19 + 6 versus 12 + 6 mmHg, p = 0.01), lower mean arterial pressure (65 + 13 versus 81 +, 13 mmHg, p = 0.04) and higher NTproBNP (6898 + 4631 versus 2944 + 2648 pg/ml, p = 0.05) without significant differences in inflammatory status between those who survived and those who died. Heart failure, exhibited by elevated venous pressure, B-type natriuretic peptide, and hypotension, were more likely at baseline in ventilated patients who later died during hospitalization