1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
2 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA.
J Intensive Care Med. 2018 Dec;33(12):680-686. doi: 10.1177/0885066616684774. Epub 2016 Dec 21.
: Left ventricular systolic dysfunction (LVSD) and LV diastolic dysfunction (LVDD) are commonly seen in severe sepsis and septic shock; however, their role in patients with concurrent invasive mechanical ventilation (IMV) is less well defined.
: This was a prospective observational study on all patients admitted to all the intensive care units (ICUs) at Mayo Clinic, Rochester from August 2007 to January 2009. All adult patients with severe sepsis and septic shock and concurrent IMV without prior heart failure underwent transthoracic echocardiography within 24 hours. Patients with active pregnancy, prior congenital or valvular heart disease, and prosthetic cardiac valves were excluded. Left ventricular systolic dysfunction was defined as LV ejection fraction (LVEF) <50% and LVDD as E/e' >15. Primary outcome was hospital mortality, and secondary outcomes included IMV duration, ICU length of stay (LOS), and total LOS. Two-tailed P value of <.05 was considered statistically significant.
: In a total of 106 patients, 58 (54.7%) met our inclusion criteria, with 17 (29.3%), 11 (19.0%), and 5 (8.6%) having LVSD, LVDD, and both, respectively. The cohorts with and without LVSD and LVDD did not differ significantly in their baseline characteristics and laboratory and ventilatory parameters. Compared to those without LVSD, patients with LVSD had higher LV end-systolic diameters but were not different in their left atrial diameters or E/e' ratio. Patients with LVDD had a higher E velocity and E/e' ratio compared to those without LVDD. Hospital mortality was not different in patients with and without LVSD (8 [47%] vs 21 [51%], P = 1.00) and LVDD (8 [73%] vs 21 [45%], P = .18). Secondary outcomes were not different between the 2 groups.
: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.
左心室收缩功能障碍（LVSD）和左心室舒张功能障碍（LVDD）在严重脓毒症和脓毒性休克中很常见；然而，它们在同时接受有创机械通气（IMV）的患者中的作用尚未得到充分定义。
这是一项前瞻性观察研究，纳入了 2007 年 8 月至 2009 年 1 月期间在梅奥诊所罗切斯特所有重症监护病房（ICUs）收治的所有成年严重脓毒症和脓毒性休克患者。所有同时接受有创机械通气且无既往心力衰竭的严重脓毒症和脓毒性休克患者在 24 小时内接受经胸超声心动图检查。排除妊娠、先天性或瓣膜性心脏病以及人工心脏瓣膜的患者。左心室收缩功能障碍定义为左心室射血分数（LVEF）<50%，左心室舒张功能障碍定义为 E/e' >15。主要结局为住院死亡率，次要结局包括有创机械通气时间、重症监护病房住院时间（LOS）和总 LOS。双侧 P 值<.05 为有统计学意义。
在总共 106 名患者中，有 58 名（54.7%）符合我们的纳入标准，分别有 17 名（29.3%）、11 名（19.0%）和 5 名（8.6%）患有左心室收缩功能障碍、左心室舒张功能障碍和两者兼有。左心室收缩功能障碍和左心室舒张功能障碍组在基线特征、实验室和通气参数方面无显著差异。与无左心室收缩功能障碍的患者相比，有左心室收缩功能障碍的患者左心室收缩末期直径较高，但左心房直径或 E/e' 比值无差异。有左心室舒张功能障碍的患者 E 速度和 E/e' 比值高于无左心室舒张功能障碍的患者。有左心室收缩功能障碍和无左心室收缩功能障碍的患者住院死亡率无差异（8 [47%] 比 21 [51%]，P = 1.00），有左心室舒张功能障碍和无左心室舒张功能障碍的患者住院死亡率也无差异（8 [73%] 比 21 [45%]，P =.18）。两组的次要结局也无差异。
严重脓毒症和脓毒性休克合并有创机械通气患者的左心室收缩或舒张功能障碍并不影响住院期间的结局。
