Critical care outcome of pulmonary artery hypertension

Introduction

Critical care (CC) outcome in pulmonary hypertension (PH) is not well documented, but is generally assumed to be poor. We therefore investigated the critical care outcome in 8 years of noncardiothoracic admissions to a PH supraregional centre.

Methods

We recorded the following data in PH patients admitted to CC: demography, aetiology, cardiovascular parameters including NYHA classification, R heart catheter and shuttle test distance (most recent assessment) along with organ support data. We recorded the length of stay (hours) in CC, CC and hospital outcome, 1-year survival and eventual outcome.

Results

Forty-seven patients were admitted (33 women), six required invasive ventilation, another six required non-invasive ventilation (NIV), 18 needed inotropic support and nine required CVVH. For survival to discharge, ROC analysis of shuttle distance demonstrated an asymptotic significance of P = 0.04 and an area of 0.71 (95% CI = 0.52 to 0.91) with 83% sensitivity and 65% specificity for a shuttle of 255 metres. Those with a shuttle over 255 metres had an average unit survival of 94%, 88% at hospital discharge and 47% at 1 year. Those below 255 metres had an average survival of 56%, 44% and 33%, respectively. Five out of six invasively ventilated patients died in hospital, but one lived for more than a year after discharge. Three out of six patients receiving NIV died in hospital but three lived for more than a year after discharge. Seventeen out of 18 who required inotropic support were dead at 1 year and 74% died before hospital discharge. For CVVH, five died and four lived. Overall survival: 64% survived to leave CC, 55% were discharged home alive and 34% were alive at 1 year. See Table 1.

Table 1 abstract

Conclusions

More than one-half of PH patients admitted to CC survive to be discharged home. Shuttle distance gives an indication of likely average survival.