Mechanically ventilated pulmonary arterial hypertension (PAH) patients have a worse outcome than similar patients without PAH, according to a study published in Chest and presented at the Chest 2021 Annual Meeting.

The researchers also reported that the first 24 hours after intubation is a particularly vulnerable period that may be crucial for the long-term outcomes of patients with PAH.

These findings suggest that patients with PAH need particular attention at the time of endotracheal intubation. The authors of the study stated, “early, post-intubation interventions may be of crucial relevance to improve survival in this population of patients.”

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The management of critically sick PAH patients remains challenging, with increased intensive care unit mortality in this group.

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To better understand the weaknesses in managing patients with PAH and identify interventions that could improve survival, a team of researchers led by Igor Barjaktarevic, MD, PhD, the medical director of the chronic obstructive pulmonary disease (COPD) program at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), evaluated the effect of emergent endotracheal intubation on short- and long-term outcomes in patients with PAH.

They retrospectively analyzed the medical records of 48 adult patients with groups 1 and 3 PAH from a large academic center and 110 patients without PAH who underwent emergent intubation between 2005 and 2021.

The results showed that in the PAH cohort, intubation was associated with death during hospital admission even though it was not associated with increased 24-hour mortality.

Patients with PAH also experienced more frequent acute kidney injury and needed a higher number of vasopressors compared to patients without PAH within 24 hours after intubation. The mean fraction of inspired oxygen (FiO2) at 24 hours after intubation was also higher in patients with PAH. Mortality was associated with the inability to establish adequate ventilation after intubation.

Reference

Hong A, Lee J, Toppen W, Saggar R, Barjaktarevic I. Outcomes and prognostic factors of pulmonary arterial hypertension patients undergoing emergent endotracheal intubation. Chest. 2021;160(4):A1040. doi:10.1016/j.chest.2021.07.964

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