Department of ICU, Shaanxi Provincial People's Hospital, No. 256, Youyi West Road, Beilin District, Xi'an, Shaanxi, China.
BMC Pulm Med. 2022 Jun 25;22(1):247. doi: 10.1186/s12890-022-02028-5.
Acute respiratory distress syndrome (ARDS) has high mortality and is mainly related to the circulatory failure.Therefore, real-time monitoring of cardiac function and structural changes has important clinical significance.Transthoracic echocardiography (TTE) is a simple and noninvasive real-time cardiac examination which is widely used in intensive care unit (ICU) patients.The purpose of this study was to analyze the effect of TTE on the prognosis of ICU patients with ARDS.
The data of ARDS patients were retrieved from the MIMIC-III v1.4 database and patients were divided into the TTE group and non-TTE group. The baseline data were compared between the two groups. The effect of TTE on the prognosis of ARDS patients was analyzed through multivariate logistic analysis and the propensity score (PS). The primary outcome was the 28-d mortality rate. The secondary outcomes included pulmonary artery catheter (PAC) and Pulse index continuous cardiac output (PiCCO) administration, the ventilator-free and vasopressor-free days and total intravenous infusion volume on days 1, 2 and 3 of the mechanical ventilation. To illuminate the effect of echocardiography on the outcomes of ARDS patients,a sensitivity analysis was conducted by excluding those patients receiving either PiCCO or PAC. We also performed a subgroup analysis to assess the impact of TTE timing on the prognosis of patients with ARDS.
A total of 1,346 ARDS patients were enrolled, including 519 (38.6%) cases in the TTE group and 827 (61.4%) cases in the non-TTE group. In the multivariate logistic regression, the 28-day mortality of patients in the TTE group was greatly improved (OR 0.71, 95%CI 0.55-0.92, P = 0.008). More patients in the TTE group received PAC (2% vs. 10%, P < 0.001) and the length of ICU stay in the TTE group was significantly shorter than that in the non-TTE group (17d vs.14d, P = 0.0001). The infusion volume in the TTE group was significantly less than that of the non-TTE group (6.2L vs.5.5L on day 1, P = 0.0012). Importantly, the patients in the TTE group were weaned ventilators earlier than those in the non-TTE group (ventilator-free days within 28 d: 21 d vs. 19.8 d, respectively, P = 0.071). The Kaplan-Meier survival curves showed that TTE patients had significant lower 28-day mortality than non-TTE patients (log-rank = 0.004). Subgroup analysis showed that TTE after hemodynamic disorders can not improve prognosis (OR 1.02, 95%CI 0.79-1.34, P = 0.844).
TTE was associated with improved 28-day outcomes in patients with ARDS.
急性呼吸窘迫综合征（ARDS）死亡率高，主要与循环衰竭有关。因此，实时监测心脏功能和结构变化具有重要的临床意义。经胸超声心动图（TTE）是一种简单、无创的实时心脏检查方法，广泛应用于重症监护病房（ICU）患者。本研究旨在分析 TTE 对 ICU 中 ARDS 患者预后的影响。
从 MIMIC-III v1.4 数据库中检索 ARDS 患者的数据，并将患者分为 TTE 组和非 TTE 组。比较两组患者的基线数据。通过多变量逻辑分析和倾向评分（PS）分析 TTE 对 ARDS 患者预后的影响。主要结局为 28 天死亡率。次要结局包括肺动脉导管（PAC）和脉搏指数连续心输出量（PiCCO）的使用、机械通气第 1、2、3 天的无呼吸机和无血管加压素天数以及总静脉输液量。为了说明超声心动图对 ARDS 患者结局的影响，通过排除接受 PiCCO 或 PAC 的患者进行敏感性分析。我们还进行了亚组分析，以评估 TTE 时机对 ARDS 患者预后的影响。
共纳入 1346 例 ARDS 患者，其中 TTE 组 519 例（38.6%），非 TTE 组 827 例（61.4%）。多变量逻辑回归分析显示，TTE 组患者 28 天死亡率显著改善（OR 0.71，95%CI 0.55-0.92，P=0.008）。TTE 组更多患者接受 PAC（2%比 10%，P<0.001），TTE 组 ICU 住院时间明显短于非 TTE 组（17d 比 14d，P=0.0001）。TTE 组输液量明显少于非 TTE 组（第 1 天分别为 6.2L 和 5.5L，P=0.0012）。重要的是，TTE 组患者比非 TTE 组更早脱离呼吸机（28 天内呼吸机脱机天数：21 天比 19.8 天，P=0.071）。Kaplan-Meier 生存曲线显示，TTE 患者 28 天死亡率显著低于非 TTE 患者（log-rank=0.004）。亚组分析显示，TTE 后发生血流动力学紊乱并不能改善预后（OR 1.02，95%CI 0.79-1.34，P=0.844）。
TTE 与 ARDS 患者 28 天预后的改善相关。
