Unanticipated critical findings on echocardiography in septic patients

Abstract

Background: Echocardiography is increasingly performed among septic patients as a routine part of evaluation and management in the intensive care unit (ICU). The rate of unanticipated critical findings (e.g., severe left or right ventricular dysfunction or pericardial tamponade) on such echocardiograms is unknown. We evaluated a retrospective cohort of septic ICU patients in whom transthoracic echocardiography was performed as a routine part of sepsis management. In addition to identifying critical findings, we defined whether each critical finding was anticipated, and whether the clinical team responded to the critical finding. The primary outcome was rate of unanticipated critical findings, which we hypothesized would occur in fewer than 5% of patients. We also performed an exploratory analysis of the association between unanticipated critical finding and mortality, controlling for severity of illness. Results: We studied 393 patients. Unanticipated critical findings were identified in 5% (95% CI 3-7%) of patients (n = 20). Among the 20 patients with unanticipated critical findings, a response to the unanticipated critical finding was identified in 12 (60%) patients. An unanticipated critical finding was not significantly associated with 28-day mortality when controlling for admission APACHE II (p = 0.27). Conclusions: Unanticipated critical findings on echocardiograms in septic ICU patients are uncommon. The potential therapeutic relevance of echocardiography to sepsis is more likely related to hemodynamic management than to traditional cardiac diagnoses. Research studies that employ blinded echocardiograms in septic patients may anticipate unblinding for critical findings approximately 1 in every 20 echocardiograms.

The diagnostic capabilities of the combined cardiac and lung point of care ultrasound in shocked patients at the emergency department – Resourced limited country

“…Cardiac ultrasound can be a useful tool in the septic patient because it enables for early detection of sepsis-related cardiac dysfunction which our study identified various level of cardiac contractility in this group. Another study [31] demonstrated cardiac ultrasound may identify an unanticipated critical finding in sepsis patient. Moreover, B-line artifacts finding appeared to represent the left ventricular function and volume status of the patient [32] , [33] .…”

Using Transthoracic Echocardiography to Predict Fluid Responsiveness after Passive Leg Raising Test: Caution Needed

“…Cardiac output and SV measurements using VTI obtained by TTE have its limitations apart from being non-continuous. 3 The VTI measurements are subject to individual variation due to various reasons. First, it requires skill to obtain an optimal image in which the ultrasound beam is aligned with cardiac structures especially obtaining the alignment of the Doppler angle parallel to blood flow.…”