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A Hemodynamic Echocardiographic Evaluation Predicts Prolonged Mechanical Ventilation in Septic Patients: A Pilot Study

      Abstract—

      Prolonged mechanical ventilation (PMV) is common among critically ill septic patients and leads to serious adverse effects. Transthoracic echocardiography (TTE) is an efficient tool for the assessment of septic shock. Our study investigated the relationship between TTE parameters and PMV in mechanically ventilated septic shock patients. TTE was performed in the first 24 h of intensive care unit admission, acquiring data on cardiac output (CO), cardiac index (CI), s' wave (s'), E wave (E), e' wave (e') and E/e' ratio. We compared data on patients who met the criteria for PMV with data on patients who did not. Sixty-four patients were included, 26 of whom met the criteria for PMV. CO, CI and s' were higher in patients who required PMV (5.49 vs. 4.20, p = 0.02; 2.95 vs. 2.34, p = 0.04; and 12.56 vs. 9.81, p = 0.01, respectively). CI correlated with s' (r = 0.37, p < 0.01). The areas under the receiver operating characteristic curves for CO, CI and s' in assessing the need for PMV were, respectively, 0.7 (fair results), 0.69 and 0.68 (poor results). Despite a lack of a prognostic model, the observed differences suggest that hemodynamic TTE could provide information on the risk of PMV in septic shock.

      Key Words

      Abbreviations:

      ICU (Intensive Care Unit), OI (Orotracheal Intubation), MV (Mechanical Ventilation), ARDS (Acute Respiratory Distress Syndrome), CO (Cardiac Output), SVR (Systemic Vascular Resistance), LV (Left Ventricle), TTE (Transthoracic Echocardiography), CI (Cardiac Index), TDI (Tissue Doppler Imaging), PMV (Prolonged Mechanical Ventilation), CCI (Chronic Critical Illness), ER (Emergency Room), NYHA (New York Heart Association), SBT (Spontaneous Breathing Trial), SV (Stroke Volume), HR (Heart Rate), LVOT CSA (Left Ventricular Outflow Tract Cross-Sectional Area), LVOT VTI (Left Ventricular Outflow Tract Velocity-Time Integral), RR (Respiratory Rate), BSA (Body Surface Area), MLE (Maximum likelihood estimation), LVEF (Left Ventricular Ejection Fraction)
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      References

        • Afandy ME
        • El Sharkawy SI
        • Omara AF.
        Transthoracic echocardiographic versus cardiometry derived indices in management of septic patients.
        Egypt J Anaesth. 2020; 36: 312-318
        • Ambrosino N
        • Vitacca M.
        The patient needing prolonged mechanical ventilation: A narrative review.
        Multidiscip Respir Med. 2018; 13: 6
        • Baumgartner JD
        • Vaney C
        • Perret C.
        An extreme form of the hyperdynamic syndrome in septic shock.
        Intensive Care Med. 1984; 10: 245-249
        • Burk RE
        • Beesley SJ
        • Grissom CK
        • Hirshberg EL
        • Lanspa MJ
        • Brown SM.
        Echocardiography in the intensive care unit.
        Curr Cardiovasc Imaging Rep. 2017; 10: 39
        • Chang YC
        • Huang KT
        • Chen YM
        • Wang CC
        • Wang YH
        • Tseng CC
        • Lin MC
        • Fang WF.
        Ventilator dependence risk score for the prediction of prolonged mechanical ventilation in patients who survive sepsis/septic shock with respiratory failure.
        Sci Rep. 2018; 8: 5650
        • Cheung NH
        • Napolitano LM.
        Tracheostomy: Epidemiology, indications, timing, technique, and outcomes.
        Respir Care. 2014; 59: 895-915
        • Damuth E
        • Mitchell JA
        • Bartock JL
        • Roberts BW
        • Trzeciak S.
        Long-term survival of critically ill patients treated with prolonged mechanical ventilation: A systematic review and meta-analysis.
        Lancet Respir Med. 2015; 3: 544-553
        • Dhand R
        • Johnson JC.
        Care of the chronic tracheostomy.
        Respir Care. 2006; 51: 984-1001
        • Ehrman RR
        • Sullivan AN
        • Favot MJ
        • Sherwin RL
        • Reynolds CA
        • Abidov A
        • Levy PD.
        Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: A review of the literature.
        Crit Care. 2018; 22: 112
        • Emilsson K
        • Alam M
        • Wandt B.
        The relation between mitral annulus motion and ejection fraction: A nonlinear function.
        J Am Soc Echocardiogr. 2000; 13: 896-901
        • Eworuke E
        • Major JM
        • McClain LG.
        National incidence rates for acute respiratory distress syndrome (ARDS) and ARDS cause-specific factors in the United States (2006–2014).
        J Crit Care. 2018; 47: 192-197
        • Funk GC
        • Anders S
        • Breyer MK
        • Burghuber OC
        • Edelmann G
        • Heindl W
        • Hinterholzer G
        • Kohansal R
        • Schuster R
        • Schwarzmaier-D'Assie
        • Valentin A
        • Hartl S.
        Incidence and outcome of weaning from mechanical ventilation according to new categories.
        Eur Respir J. 2010; 35: 88-94
        • Gaubert M
        • Resseguier N
        • Thuny F
        • Paganelli F
        • Cautela J
        • Pinto J
        • Ammar C
        • Laine M
        • Bonello L.
        Doppler echocardiography for assessment of systemic vascular resistances in cardiogenic shock patients.
        Eur Heart J Acute Cardiovasc Care. 2020; 9: 102-107
        • Gerbaud E
        • Erickson M
        • Grenouillet-Delacre M
        • Beauvieux MC
        • Coste P
        • Durrieu-Jais C
        • Hilbert G
        • Castaing Y
        • Vargas F.
        Echocardiographic evaluation and N-terminal pro-brain natriuretic peptide measurement of patients hospitalized for heart failure during weaning from mechanical ventilation.
        Minerva Anestesiol. 2012; 78: 415-425
        • Groeneveld ABJ
        • Nauta JJP
        • Thijs LG.
        Peripheral vascular resistance in septic shock: Its relation to outcome.
        Intensive Care Med. 1988; 14: 141-147
        • Ho CY
        • Solomon SD.
        A clinician's guide to tissue Doppler imaging.
        Circulation. 2006; 113: e396-e398
        • Ihlen H
        • Amlie JP
        • Dale J
        • Forfang K
        • Nitter-Hauge S
        • Otterstad JE
        • Simonsen S
        • Myhre E.
        Determination of cardiac output by Doppler echocardiography.
        Br Heart J. 1984; 51: 54-60
        • Kahn JM
        • Le T
        • Angus DC
        • Cox CE
        • Hough CL
        • White DB
        • Yende S
        • Carson SS
        ProVent Study Group Investigators. The epidemiology of chronic critical illness in the United States.
        Crit Care Med. 2015; 43: 282-287
        • Kakihana Y
        • Ito T
        • Nakahara M
        • Yamaguchi K
        • Yasuda T.
        Sepsis-induced myocardial dysfunction: Pathophysiology and management.
        J Intensive Care. 2016; 4: 22
        • Mayo P
        • Volpicelli G
        • Lerolle N
        • Schreiber A
        • Doelken P
        • Vieillard-Baron A.
        Ultrasonography evaluation during the weaning process: The heart, the diaphragm, the pleura and the lung.
        Intensive Care Med. 2016; 42: 1107-1117
        • Mercado P
        • Maizel J
        • Beyls C
        • Titeca-Beauport D
        • Joris M
        • Kontar L
        • Riviere A
        • Bonef O
        • Soupison T
        • Tribouilloy C
        • de Cagny B
        • Slama M.
        Transthoracic echocardiography: An accurate and precise method for estimating cardiac output in the critically ill patient.
        Crit Care. 2017; 21: 136
        • Monnet X
        • Marik PE
        • Teboul JL.
        Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis.
        Intensive Care Med. 2016; 42: 1935-1947
        • Moore S
        • Weiss B
        • Pascual JL
        • Kaplan LJ.
        Management of acute respiratory failure in the patient with sepsis and septic shock.
        Surg Infect. 2018; 19: 191-201
        • Moschietto S
        • Doyen D
        • Grech L
        • Dellamonica J
        • Hyvernat H
        • Bernardin G.
        Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: Evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome.
        Crit Care. 2012; 16: R81
        • Nagueh SF
        • Middleton KJ
        • Kopelen HA
        • Zoghbi WA
        • Quiñones MA.
        Doppler tissue imaging: A noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures.
        J Am Coll Cardiol. 1997; 30: 1527-1533
        • Nelson JE
        • Cox CE
        • Hope AA
        • Carson SS.
        Chronic critical illness.
        Am J Respir Crit Care Med. 2010; 182: 446-454
        • Ommen SR
        • Nishimura RA
        • Appleton CP
        • Miller FA
        • Oh JK
        • Redfield MM
        • Tajik AJ.
        Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study.
        Circulation. 2000; 102: 1788-1794
        • Parker MM
        • Shelhamer JH
        • Natanson C
        • Alling DW
        • Parrillo JE.
        Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: Heart rate as an early predictor of prognosis.
        Crit Care Med. 1987; 15: 923-929
        • Rhodes A
        • Evans LE
        • Alhazzani W
        • Levy MM
        • Antonelli M
        • Ferrer R
        • Kumar A
        • Sevransky JE
        • Sprung CL
        • Nunnally ME
        • Rochwerg B
        • Rubenfeld GD
        • Angus DC
        • Annane D
        • Beale RJ
        • Bellinghan GJ
        • Bernard GR
        • Chiche JD
        • Coopersmith C
        • De Backer DP
        • French CJ
        • Fujishima S
        • Gerlach H
        • Hidalgo JL
        • Hollenberg SM
        • Jones AE
        • Karnad DR
        • Kleinpell RM
        • Koh Y
        • Lisboa TC
        • Machado FR
        • Marini JJ
        • Marshall JC
        • Mazuski JE
        • McIntyre LA
        • McLean AS
        • Mehta S
        • Moreno RP
        • Myburgh J
        • Navalesi P
        • Nishida O
        • Osborn TM
        • Perner A
        • Plunkett CM
        • Ranieri M
        • Schorr CA
        • Seckel MA
        • Seymour CW
        • Shieh L
        • Shukri KA
        • Simpson SQ
        • Singer M
        • Thompson BT
        • Townsend SR
        • Van der Poll T
        • Vincent JL
        • Wiersinga WJ
        • Zimmerman JL
        • Dellinger RP.
        Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
        Intensive Care Med. 2016; 43: 304-377
        • Sanfilippo F
        • Corredor C
        • Fletcher N
        • Landsberg G
        • Benedetto U
        • Foex P
        • Cecconi M.
        Diastolic dysfunction and mortality in septic patients: A systematic review and meta-analysis.
        Intensive Care Med. 2015; 41: 1004-1013
        • Sanfilippo F
        • Di Falco D
        • Noto A
        • Santonocito C
        • Morelli A
        • Bignami E
        • Scolletta S
        • Viellard-Baron A
        • Astuto M.
        Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: A systematic review and meta-analysis.
        Br J Anaesth. 2021; 126: 319-330
        • Szabó B
        • Marosi EK
        • Vargová K
        • Nyolczas N.
        Cardiac Index by Transthoracic Echocardiography (CITE) study.
        PLoS One. 2018; 13e0207269
        • Uemura K
        • Kawada T
        • Sunagawa K
        • Sugimachi M.
        Peak systolic mitral annulus velocity reflects the status of ventricular–arterial coupling—Theoretical and experimental analyses.
        J Am Soc Echocardiogr. 2011; 24: 582-591
        • Vieillard-Baron A
        • Caille V
        • Charron C
        • Belliard G
        • Page B
        • Jardin F.
        Actual incidence of global left ventricular hypokinesia in adult septic shock.
        Crit Care Med. 2008; 36: 1701-1706
        • Vincent JL
        • Jones G
        • David S
        • Olariu E
        • Cadwell KK.
        Frequency and mortality of septic shock in Europe and North America: A systematic review and meta-analysis.
        Crit Care. 2019; 23: 196
        • Wang Y
        • Moss J
        • Thisted R.
        Predictors of body surface area.
        J Clin Anesth. 1992; 4: 4-10
        • Weng L
        • Liu YT
        • Du B
        • Zhou JF
        • Guo XX
        • Peng JM
        • Hu XY
        • Zhang SY
        • Fang Q
        • Zhu WL.
        The prognostic value of left ventricular systolic function measured by tissue Doppler imaging in septic shock.
        Crit Care. 2012; 16: R71
        • Zanotti-Cavazzoni SL
        • Hollenberg SM.
        Cardiac dysfunction in severe sepsis and septic shock.
        Curr Opin Crit Care. 2009; 15: 392-397