Bootsma Inge T, Scheeren Thomas W L, de Lange Fellery, Haenen Johannes, Boonstra Piet W, Boerma E Christaan
1Department of Intensive Care, Medical Centre Leeuwarden, Henri Dunantweg 2, P.O. Box 888, 8901 Leeuwarden, the Netherlands.
Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
J Intensive Care. 2018 Dec 27;6:85. doi: 10.1186/s40560-018-0351-3. eCollection 2018.
Right ventricular (RV) dysfunction is a known risk factor for increased mortality in cardiac surgery. However, the association between RV performance and ICU morbidity is largely unknown.
We performed a single-centre, retrospective study including cardiac surgery patients equipped with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements. Primary endpoint of our study was ICU morbidity (as determined by ICU length of stay, duration of mechanical ventilation, usage of inotropic drugs and fluids, and kidney dysfunction) in relation to RVEF. Patients were divided into three groups according to their RVEF; < 20%, 20-30%, and > 30%.
We included 1109 patients. Patients with a RVEF < 20% had a significantly longer stay in ICU, a longer duration of mechanical ventilation, higher fluid balance, a higher incidence of inotropic drug usage, and more increase in postoperative creatinine levels in comparison to the other subgroups. In a multivariate analysis, RVEF was independently associated with increased ICU length of stay (OR 0.934 CI 0.908-0.961, < 0.001), prolonged duration of mechanical ventilation (OR 0.969, CI 0.942-0.998, = 0.033), usage of inotropic drugs (OR 0.944, CI 0.917-0.971, < 0.001), and increase in creatinine (OR 0.962, CI 0.934-0.991, = 0.011).
A decreased RVEF is independently associated with a complicated ICU stay.
右心室（RV）功能障碍是心脏手术中死亡率增加的已知危险因素。然而，右心室功能与重症监护病房（ICU）发病率之间的关联在很大程度上尚不清楚。
我们进行了一项单中心回顾性研究，纳入配备肺动脉导管的心脏手术患者，以能够连续测量右心室射血分数（RVEF）。我们研究的主要终点是与RVEF相关的ICU发病率（由ICU住院时间、机械通气时间、使用血管活性药物和液体情况以及肾功能障碍确定）。根据RVEF将患者分为三组；<20%、20 - 30%和>30%。
我们纳入了1109例患者。与其他亚组相比，RVEF<20%的患者在ICU的住院时间显著更长、机械通气时间更长、液体平衡更高、血管活性药物使用发生率更高，术后肌酐水平升高更多。在多变量分析中，RVEF与ICU住院时间延长（比值比[OR]0.934，置信区间[CI]0.908 - 0.961，P<0.001）、机械通气时间延长（OR 0.969，CI 0.942 - 0.998，P = 0.033）、血管活性药物使用（OR 0.944，CI 0.917 - 0.971，P<0.001）以及肌酐升高（OR 0.962，CI 0.934 - 0.991，P = 0.011）独立相关。
RVEF降低与ICU住院复杂情况独立相关。
