Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients
Epidemiology and management of atrial fibrillation in medical and noncardiac surgical adult intensive care unit patients
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DOI：
10.1016/j.jcrc.2011.10.011
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发表时间：
2012-06-01
影响因子：
3.7
通讯作者：
McIntyre, Lauralyn
中科院分区：
文献类型：
--
作者：
Kanji, Salmaan;Williamson, David R.;McIntyre, Lauralyn
目的：本研究的目的是描述的流行病学和管理的房颤（AF）在非心脏手术危重患者在一项回顾性，观察性研究，在3个混合的医疗，外科，大学附属重症监护病房（ICUs）。方法：在1年的时间内，任何文件的AF在ICU住院的连续性患者入院进行了鉴定。人口统计学数据，危险因素，干预措施和结果收集的医疗record.Results：共3081例患者入院在1年的研究期间，其中348例连续患者（10.5%）记录AF。房颤是新发139例（4.5%）和预先存在的186例（6.0%）。新发AF患者和既存AF患者中分别有37%和10%发生血流动力学不稳定。大多数（73%）新发AF患者至少有1个可改变的风险因素。分别有76%和26%的新发AF患者和既存AF患者尝试了药物心律转换。虽然87%的新发病例最初成功，但42%的病例恢复为AF。新发AF患者和既存AF患者中，分别有7/26（27%）和0/5（0%）的患者电转换成功。总共有18%和62%的新发AF患者和既存AF患者，分别存活到ICU出院离开ICU的AF。结论：房颤是常见的，但在大多数ICU患者中是短暂的。电击复律通常不成功，药物心律转换通常仅短暂有效。可改变的风险因素在这些患者中很常见。未来的研究需要解决ICU中AF的管理问题。(C)2012 Elsevier Inc. All rights reserved.
Purpose: The aim of the study was to describe the epidemiology and management of atrial fibrillation (AF) in noncardiac surgery critically ill patients in a retrospective, observational study at 3 mixed medical-surgical, university-affiliated intensive care units (ICUs).Methods: Consecutive patients admitted during a 1-year period with any documentation of AF during ICU stay were identified. Demographic data, risk factors, interventions, and outcomes were collected from the medical record.Results: A total of 3081 patients were admitted during the 1-year study period in which 348 consecutive patients (10.5%) had documented AF. Atrial fibrillation was of new onset in 139 patients (4.5%) and preexisting in 186 patients (6.0%). Hemodynamic instability developed in 37% and 10% of patients with new-onset AF and patients with preexisting AF, respectively. Most (73%) patients with new-onset AF had at least 1 modifiable risk factor. Pharmacologic rhythm conversion was attempted in 76% and 26% of patients with new-onset AF and patients with preexisting AF, respectively. Although initially successful in 87% of new-onset cases, 42% reverted back to AF. Electrical conversion was successful in 7 (27%) of 26 and 0 (0%) of 5 of patients with new-onset AF and patients with preexisting AF, respectively. In total, 18% and 62% of patients with new-onset AF and patients with preexisting AF, respectively, who survived to ICU discharge left the ICU in AF.Conclusions: Atrial fibrillation is common but transient in most ICU patients. Electrical cardioversion is often unsuccessful, and pharmacologic rhythm conversion is often only transiently effective. Modifiable risk factors are common among these patients. Future studies are needed to address the management of AF in the ICU. (C) 2012 Elsevier Inc. All rights reserved.