Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

Saraschandra Vallabhajosyula; Shane M Gillespie; David W Barbara; Nandan S Anavekar; Juan N Pulido

doi:10.1177/0885066616684774

Impact of New-Onset Left Ventricular Dysfunction on Outcomes in Mechanically Ventilated Patients With Severe Sepsis and Septic Shock

J Intensive Care Med. 2018 Dec;33(12):680-686. doi: 10.1177/0885066616684774. Epub 2016 Dec 21.

Authors

Saraschandra Vallabhajosyula^{1

2}, Shane M Gillespie³, David W Barbara³, Nandan S Anavekar^{4

5}, Juan N Pulido⁶

Affiliations

¹ 1 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
² 2 Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic, Rochester, MN, USA.
³ 3 Divisions of Cardiothoracic and Critical Care Anesthesiology, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
⁴ 4 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
⁵ 5 Division of Cardiac Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA.
⁶ 6 Cardiothoracic Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Swedish Heart and Vascular Institute, Seattle, WA, USA.

PMID: 28553776
DOI: 10.1177/0885066616684774

Abstract

Background:: 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.

Methods:: 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.

Results:: 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.

Conclusion:: Left ventricular systolic or diastolic dysfunction did not influence in-hospital outcomes in patients with severe sepsis and septic shock and concurrent IMV.

Keywords: cardiac critical care; critical care; left ventricular dysfunction; mechanical ventilation; septic shock; severe sepsis.

Publication types

Observational Study

MeSH terms

Critical Care*
Echocardiography
Hospital Mortality
Humans
Prospective Studies
Respiration, Artificial*
Sepsis / diagnostic imaging
Sepsis / mortality
Sepsis / physiopathology*
Sepsis / therapy*
Shock, Septic / diagnostic imaging
Shock, Septic / mortality
Shock, Septic / physiopathology*
Shock, Septic / therapy*
Treatment Outcome
Ventricular Dysfunction, Left / etiology*