Echocardiographic parameters of patients in the intensive care unit undergoing continuous renal replacement therapy

Abstract

Main objectivesEchocardiographic parameters have been used to predict outcomes for specific intensive care unit (ICU) populations. We sought to define echocardiographic parameters for ICU patients receiving continuous renal replacement therapy (CRRT).Design, setting, participants, and measurementsThis is a historical cohort study of consecutive ICU patients at Mayo Clinic (Rochester, Minnesota) who received CRRT from December 9, 2006, through November 13, 2015. Only patients with an echocardiographic examination within 7 days of CRRT initiation were considered.ResultsThe study included 1,276 patients. Decreased left ventricular ejection fraction (LVEF; ≤45%) was noted in 361/1,120 (32%) and increased right ventricular systolic pressure (RVSP; ≥40 mm Hg) was noted in 529/798 (66%). Right ventricular systolic dysfunction was observed in 320/820 (39%). The most common valvular abnormality was tricuspid regurgitation (244/1,276 [19%]). Stratification of these parameters by ICU type (medical, surgical, cardiothoracic, cardiac) showed that most echocardiographic abnormalities were significantly more prevalent among cardiac ICU patients: LVEF ≤45% (67/105 [64%]), RVSP ≥40 mm Hg (63/79 [80%]) and tricuspid regurgitation (50/130 [38%]). We compared patients with acute kidney injury (AKI) vs end-stage renal disease and showed that decreased LVEF (284/921 [31%] vs 78/201 [39%]), was significantly less prevalent among patients with AKI, but increased RVSP was more prevalent (445/651 [68%] vs 84/147 [57%]) with AKI.ConclusionsICU patients who required CRRT had increased prevalence of pulmonary hypertension and right and left ventricular systolic dysfunction. Prediction of adverse outcomes with echocardiographic parameters in this patient population can lead to identification of modifiable risk factors.

Right ventricular function is associated with 28-day mortality in myocardial infarction complicated by cardiogenic shock: A retrospective observational study

“…Also, patients requiring RRT in cardiac and cardiothoracic ICU had a 50% prevalence of RV dysfunction. 33 In line with previous investigations, TAPSE was lower in patients requiring RRT in this study. Perhaps with a bigger sample size, TAPSE or other RV parameters (e.g.…”

Distant organ dysfunction in acute kidney injury

“…20 Moreover, a higher diuretic dose after AKI had a protective effect on patient survival, suggesting that survival may be linked to improved fluid balance in patients with AKI. 7,23 Pulmonary congestion and oedema may also occur without fluid overload in patients with AKI. 21 Similarly, sepsis studies suggest that fluid resuscitation for the prevention of AKI is most effective if given early and in a targeted manner to prevent excessive fluid administration but to maximize haemodynamic parameters.…”

“…22 Fluid overload, together with uraemic solute retention and an acid/base imbalance, in patients with AKI may also lead to the development of pulmonary hypertension and right ventricular stress in susceptible patients through pulmonary vascular dysfunction and pulmonary congestion ( Figure 2). 7,23 Pulmonary congestion and oedema may also occur without fluid overload in patients with AKI. In 1951, Bass et al 24 described the uraemic lung as having a "central butterfly" appearance in radiographs and it was associated with left ventricular failure and advanced kidney disease.…”

Prognostic Impact of Left compared to Right Heart Function in Sepsis and Septic Shock

“…9 Because there is no set definition of LV systolic dysfunction (LVSD) in patients with sepsis or septic shock despite several studies investigating this subject, patients were stratified for LVEF of less than 45% or greater than or equal to 45% as assessed during the first 24 hours of ICU admission in accordance with previous studies. [10][11][12][13][14] Corresponding to current recommendations for cardiac chamber quantification by the American Society of Echocardiography and the European Association of Cardiovascular Imaging, right ventricular systolic dysfunction (RVSD) was considered to be present in patients with TAPSE of less than 17 mm as measured during the first 24 hours of ICU admission. 15 All-cause mortality at 30 days was documented by using our electronic hospital information system and directly contacting state resident registration offices ("bureau of mortality statistics").…”