Value of early critical care transthoracic echocardiography for patients undergoing mechanical ventilation: a retrospective study

Hao Jiang; Wen Xu; Wenjing Chen; Lingling Pan; Xueshu Yu; Yincai Ye; Zhendong Fang; Xianwei Zhang; Zhiqiang Chen; Jie Shu; Jingye Pan

doi:10.1136/bmjopen-2021-048646

Value of early critical care transthoracic echocardiography for patients undergoing mechanical ventilation: a retrospective study

BMJ Open. 2021 Oct 21;11(10):e048646. doi: 10.1136/bmjopen-2021-048646.

Authors

Hao Jiang^{1

2}, Wen Xu³, Wenjing Chen^{1

4}, Lingling Pan¹, Xueshu Yu¹, Yincai Ye⁵, Zhendong Fang¹, Xianwei Zhang¹, Zhiqiang Chen¹, Jie Shu¹, Jingye Pan^{6

7}

Affiliations

¹ Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
² Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Provincial, Wenzhou, Zhejiang, China.
³ Department of Hepatobiliary and pancreatic surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, Zhejiang, China.
⁴ Wenzhou Key Laboratory of Critical Care and Artificial Intelligence, Wenzhou, China.
⁵ Department of Blood Transfusion, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
⁶ Department of Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China wmupanjingye@126.com.
⁷ The Project of Application Technology Collaborative Innovation Center of Wenzhou Institutions of Higher-Learning - Collaborative Innovation Center of Intelligence Medical Education, Wenzhou, China.

Abstract

Objectives: To evaluate whether early intensive care transthoracic echocardiography (TTE) can improve the prognosis of patients with mechanical ventilation (MV).

Design: A retrospective cohort study.

Setting: 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.

Participants: 2931 and 6236 patients were recruited from the MIMIC-III database and the eICU database, respectively.

Primary and secondary outcome measures: 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.

Results: 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).

Conclusions: 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.

Keywords: adult intensive & critical care; echocardiography; intensive & critical care; ultrasound.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Critical Care
Echocardiography
Humans
Intensive Care Units*
Respiration, Artificial*
Retrospective Studies