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Predictors and clinical impact of invasive mechanical ventilation in cardiogenic shock patients

Session: Sessão de Posters 23 - Choque cardiogénico: preditores, suporte e desfechos
Speaker: Marta Catarina Almeida

Congress: CPC 2026
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Session Type: Posters Eletrónicos
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Authors: Marta Leite; Marta Catarina Almeida; André Lobo; Inês Neves; Adelaide Dias; Marisa Silva; Marta Ponte; Pedro Gonçalves Teixeira; Gualter Santos Silva; Ricardo Fontes-Carvalho

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Background:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Invasive mechanical ventilation (IMV) is a respiratory support used in patients with cardiogenic shock (CS) to reduce work of breathing and mitigate secondary organ dysfunction. Despite its clinical importance, the determinants leading to IMV initiation in CS and the extent to which IMV independently influences outcomes remain insufficiently defined. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Purpose:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> The aim of the study was to predict IMV use and to evaluate its impact on CS patients.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> Retrospective analysis of CS patients in a cardiac unit in 5 years was conducted. Demographics, comorbidities, diagnosis, analytic data at presentation, SCAI classification, clinical and analytic data at admission, additional support, and in-hospital mortality were registered. Patients who needed IMV were compared to patients without IMV. Chi-square, Mann-Whitney, Kruskal-Wallis and logistic regression were used.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Results:</span></strong><span style="font-family:&quot;Arial&quot;,sans-serif"> In 175 patients with CS, IMV was needed in half of the patients (n = 89, 50.9%). A comparison of patients with and without IMV is in Table 1. Age was lower in patients submitted to IMV (60 [19] <em>versus</em> 73 [19] years old, p &lt;0.001). Regarding comorbidities, smoking habits were associated with higher need of IMV (OR = 2.318, p = 0.009) and history of heart failure (OR = 0.380, p = 0.016) and atrial fibrillation (OR = 0.242, p = 0.006) with lower need. SCAI classification correlated with IMV (R<sup>2</sup> = 0.193, p &lt;0.001). Lower systolic blood pressure at admission (p &lt;0.001) and NTproBNP (p = 0.021) and higher lactate levels (p &lt;0.001) were verified in patients submitted to IMV. In the multivariate logistic analysis (R<sup>2 </sup>= 0.411, p &lt;0.001), IMV use was independently predicted by age (p = 0.006), SCAI classification (p = 0.027) and blood pressure (p = 0.042). Renal replacement therapy (OR = 2.922, p = 0.039) and mechanical circulatory support use (OR 2.010, p = 0.032) were higher in IMV patients. Mortality did not differ significantly between patients with and without IMV.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion: </span></strong><span style="font-family:&quot;Arial&quot;,sans-serif">In this cohort of patients with CS, IMV was required in approximately half of cases. Younger age, higher SCAI shock stage, and lower systolic blood pressure independently predicted the need for invasive ventilatory support. Patients requiring IMV also demonstrated more severe clinical and analytic derangement and more frequently required advanced supportive therapies. Despite these indicators of greater illness severity, in-hospital mortality did not significantly differ between patients with and without mechanical ventilation. These findings highlight key predictors of ventilatory need and suggest that IMV itself may serve as a marker of disease severity rather than adversely influence on survival in CS.</span></span></span></p>

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