Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Provincial, Wenzhou, Zhejiang, China.
BMJ Open. 2021 Oct 21;11(10):e048646. doi: 10.1136/bmjopen-2021-048646.
To evaluate whether early intensive care transthoracic echocardiography (TTE) can improve the prognosis of patients with mechanical ventilation (MV).
A retrospective cohort study.
Patients undergoing MV for more than 48 hours, based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD), were selected.
2931 and 6236 patients were recruited from the MIMIC-III database and the eICU database, respectively.
The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality from the date of ICU admission, days free of MV and vasopressors 30 days after ICU admission, use of vasoactive drugs, total intravenous fluid and ventilator settings during the first day of MV.
We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality (MIMIC: OR 0.78; 95% CI 0.65 to 0.94, p=0.01; eICU-CRD: OR 0.76; 95% CI 0.67 to 0.86, p<0.01). Early TTE was also associated with 30-day mortality in the MIMIC database (OR 0.71, 95% CI 0.57 to 0.88, p=0.001). Furthermore, those who had early TTE had both more ventilation-free days (only in eICU-CRD: 23.48 vs 24.57, p<0.01) and more vasopressor-free days (MIMIC: 18.22 vs 20.64, p=0.005; eICU-CRD: 27.37 vs 28.59, p<0.001) than the control group (TTE applied outside of the early TTE and no TTE at all).
Early application of critical care TTE during MV is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.
评估早期重症监护经胸超声心动图（TTE）是否能改善机械通气（MV）患者的预后。
回顾性队列研究。
根据医学信息集市重症监护 III 期（MIMIC-III）数据库和电子重症监护协作研究数据库（eICU-CRD），选择 MV 持续时间超过 48 小时的患者。
分别从 MIMIC-III 数据库和 eICU 数据库中招募了 2931 名和 6236 名患者。
主要结局为院内死亡率。次要结局为 ICU 入院日期后 30 天死亡率、ICU 入院后 30 天无 MV 和血管加压药天数、血管活性药物使用、MV 第 1 天的总静脉液体和呼吸机设置。
我们使用倾向评分匹配来分析早期 TTE 与院内死亡率之间的关联，并进行敏感性分析，包括逆概率加权模型和协变量平衡倾向评分模型，以确保我们研究结果的稳健性。调整后的 OR 显示早期 TTE 组与院内死亡率之间存在有利关联（MIMIC：OR 0.78；95%CI 0.65 至 0.94，p=0.01；eICU-CRD：OR 0.76；95%CI 0.67 至 0.86，p<0.01）。早期 TTE 也与 MIMIC 数据库中的 30 天死亡率相关（OR 0.71，95%CI 0.57 至 0.88，p=0.001）。此外，早期 TTE 组的无通气天数（仅在 eICU-CRD 中：23.48 与 24.57，p<0.01）和无血管加压药天数（MIMIC：18.22 与 20.64，p=0.005；eICU-CRD：27.37 与 28.59，p<0.001）均多于对照组（TTE 在早期 TTE 之外应用和根本没有 TTE）。
在 MV 期间早期应用重症监护 TTE 有利于改善院内死亡率。需要前瞻性收集数据进行进一步研究以验证这种关系。
