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Critical Care |

Prolonged QTc Is Not Associated With Worse Clinical Outcomes in Mechanically Ventilated Patients

Juan Fernandez*, MD; Antonio Anzueto, MD; Katherine Durham, MD; Nazila Naderi, MD; Joe Moody, MD; Marcos Restrepo, MD
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UTHSCSA, San Antonio, TX


Chest. 2012;142(4_MeetingAbstracts):394A. doi:10.1378/chest.1390349
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Abstract

SESSION TYPE: Non Pulmonary Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Prolonged QTc precludes many therapies in the intensive care unit (ICU) and is associated with significant cardiovascular morbidity, mortality and higher risk of ventricular arrhythmias. Little is known about the significance of QTc prolongation in critically ill patients. Our aim was to evaluate the impact of prolonged QTc on clinical outcomes in critically ill patients requiring mechanical ventilation.

METHODS: A retrospective cohort study of critically ill patients requiring invasive mechanical ventilation (MV) for ≥ 1day were identified from January 1 to December 31, 2007. Inclusion criteria required an available electrocardiogram (ECG) at the time of admission to the ICU or initiation of MV. Prolonged QTc was defined as an interval of > 500 msec in one ECG. Primary outcome was a composite outcome mortality, cardiorespiratory arrest and/or ventricular tachycardia or fibrillation during hospitalization. Chi-square and Student s t-test were used to compare categorical and continuous variables, respectively. Multivariable analysis was performed using the composite outcome as the dependent variable and APACHE II score and prolonged QT as the independent variables.

RESULTS: We identified 112 patients with ECG at the time of ICU admission or MV. A prolonged QTc interval was present in 17 (15.2%) of the critically ill patients. The mean APACHE II was 23.9 (SD 7.2) at the time of ICU admission. Cardiorespiratory arrest occurred in 36 (32.1%), ventricular arrhythmia in 5 (4.5%) and in-hospital mortality in 50(44.6%) subjects, respectively. Prolonged QTc was not associated with higher rate of cardiorespiratory arrest (p=0.7), ventricular arrhythmia (p=0.3) and in-hospital mortality (p=0.4). In the multivariable analysis, prolonged QTc was not associated with the composite outcome when compared to normal QTc (5 [29.4%] vs. 31 [32.6%], aOR 0.81, 95% CI 0.26-2.54, p=0.7).

CONCLUSIONS: Prolonged QTc was not associated with a composite outcome that included mortality, cardiorespiratory arrest and/or ventricular tachycardia or fibrillation during hospitalization in critically ill patients requiring MV.

CLINICAL IMPLICATIONS: Further prospective studies are needed to evaluate the impact of QTc in patients requiring MV.

DISCLOSURE: The following authors have nothing to disclose: Juan Fernandez, Antonio Anzueto, Katherine Durham, Nazila Naderi, Joe Moody, Marcos Restrepo

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UTHSCSA, San Antonio, TX

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