Beesley Sarah J, Egan Ezekiel, Lanspa Michael J, Wilson Emily L, Hirshberg Elliotte L, Grissom Colin K, Burk Rebecca, Brown Samuel M
Pulmonary Division, Intermountain Medical Center, Salt Lake City, UT, USA.
Pulmonary Division, University of Utah School of Medicine, Salt Lake City, UT, USA.
Ultrasound J. 2020 Apr 2;12(1):12. doi: 10.1186/s13089-020-00162-x.
Echocardiography is increasingly performed among septic patients as a routine part of evaluation and management in the intensive care unit (ICU). The rate of unanticipated critical findings (e.g., severe left or right ventricular dysfunction or pericardial tamponade) on such echocardiograms is unknown. We evaluated a retrospective cohort of septic ICU patients in whom transthoracic echocardiography was performed as a routine part of sepsis management. In addition to identifying critical findings, we defined whether each critical finding was anticipated, and whether the clinical team responded to the critical finding. The primary outcome was rate of unanticipated critical findings, which we hypothesized would occur in fewer than 5% of patients. We also performed an exploratory analysis of the association between unanticipated critical finding and mortality, controlling for severity of illness.
We studied 393 patients. Unanticipated critical findings were identified in 5% (95% CI 3-7%) of patients (n = 20). Among the 20 patients with unanticipated critical findings, a response to the unanticipated critical finding was identified in 12 (60%) patients. An unanticipated critical finding was not significantly associated with 28-day mortality when controlling for admission APACHE II (p = 0.27).
Unanticipated critical findings on echocardiograms in septic ICU patients are uncommon. The potential therapeutic relevance of echocardiography to sepsis is more likely related to hemodynamic management than to traditional cardiac diagnoses. Research studies that employ blinded echocardiograms in septic patients may anticipate unblinding for critical findings approximately 1 in every 20 echocardiograms.
在脓毒症患者中，超声心动图检查越来越多地作为重症监护病房（ICU）评估和管理的常规部分进行。此类超声心动图上意外关键发现（如严重左心室或右心室功能障碍或心包填塞）的发生率尚不清楚。我们评估了一组接受经胸超声心动图检查作为脓毒症管理常规部分的脓毒症ICU患者的回顾性队列。除了识别关键发现外，我们还确定了每个关键发现是否在预期之内，以及临床团队是否对关键发现做出了反应。主要结局是意外关键发现的发生率，我们假设该发生率在不到5%的患者中出现。我们还对意外关键发现与死亡率之间的关联进行了探索性分析，并对疾病严重程度进行了控制。
我们研究了393例患者。5%（95%CI 3 - 7%）的患者（n = 20）发现了意外关键发现。在这20例有意外关键发现的患者中，12例（60%）患者对意外关键发现做出了反应。在控制入院时的急性生理与慢性健康状况评分系统II（APACHE II）后，意外关键发现与28天死亡率无显著相关性（p = 0.27）。
脓毒症ICU患者超声心动图上的意外关键发现并不常见。超声心动图对脓毒症的潜在治疗相关性更可能与血流动力学管理有关，而非传统的心脏诊断。在脓毒症患者中采用盲法超声心动图的研究可能预计每20次超声心动图中约有1次会因关键发现而解除盲法。
