Critical care echocardiography is an emerging practice in the evaluation of cardiac function and volume status in patients in the intensive care unit. A consensus statement defining competence in basic and advanced critical care echocardiography was recently published. We measured whether useful information can be obtained with advanced critical care echocardiography in the setting of severe sepsis and septic shock.
Within the first 6 hours of presentation with severe sepsis or septic shock we evaluated diastolic function using pulse wave Doppler of mitral valve inflow and tissue Doppler of the mitral annulus and we measured the ratio of early diastolic mitral inflow velocity (E) to tissue Doppler mitral annulus velocity (Ea). We measured left ventricular (LV) ejection fraction (LVEF) using the method of disks. We assessed right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE). We calculated the percentage of time we were able to obtain these echocardiographic parameters.
24 patients were enrolled in the study. 54% were men. There was a 21% mortality rate. Adequate images were obtained to measure LVEF in 88% of patients; 24% of these patients had LV systolic dysfunction using a threshold of LVEF < 45%. We were able to define diastolic function by standard criteria in 75% of patients; the other 25% had either fused diastology or inadequate images. In 3 patients, E/Ea was greater than 15; 2 of these patients had restrictive diastolic physiology and 1 had impaired relaxation. Adequate images were obtained to measure RV function in 96% of patients; 26% of these patients had RV dysfunction defined by a TAPSE < 15mm. Only 1 patient had both LV and RV dysfunction.
Parameters of cardiac function can be reliably obtained using advanced critical care echocardiography in patients with severe sepsis and septic shock.
Findings from advanced critical care echocardiography may have implications for treatment of patients with severe sepsis and septic shock.
Joel Pittman, No Financial Disclosure Information; No Product/Research Disclosure Information