Right Ventricular Dysfunction in Early Sepsis and Septic Shock.
Chest
; 159(3): 1055-1063, 2021 03.
Article
em En
| MEDLINE
| ID: mdl-33068615
ABSTRACT
BACKGROUND:
Sepsis is a frequently lethal state, commonly associated with left ventricular (LV) dysfunction. Right ventricular (RV) dysfunction in sepsis is less well understood. RESEARCH QUESTION In septic patients, how common is RV dysfunction, and is it associated with worse outcomes? STUDY DESIGN ANDMETHODS:
We measured echocardiographic parameters on critically ill patients with severe sepsis or septic shock within the first 24 hours of ICU admission. We defined RV dysfunction as fractional area change (FAC) less than 35% or tricuspid annulus systolic plane excursion (TAPSE) less than 1.6 cm. We defined LV systolic dysfunction as ejection fraction (EF) less than 45% or longitudinal strain greater than -19%. Using logistic regression, we assessed the relationship between 28-day mortality and presence of RV dysfunction and LV systolic dysfunction, controlling for receipt of vasopressors, receipt of fluid, mechanical ventilation, and the acute physiology and chronic health evaluation (APACHE II) score.RESULTS:
We studied 393 patients. RV and LV dysfunction were common (48% and 63%, respectively). Mean echocardiographic values were RV end-diastolic area, 22.4 ± 7.0 cm2; RV end-systolic area, 14.2 ± 6.0 cm2; RV FAC, 38 ± 11%; TAPSE, 1.8 ± .06 cm; RV longitudinal strain, -15.3 ± 6.5%; LV EF, 60% ± 14%; LV longitudinal strain, -16.5% ± 6.0%. Patients with RV dysfunction had higher 28-day mortality (31% vs 16%, P = .001). In our multivariable regression model, RV dysfunction was associated with increased mortality (OR, 3.4; CI, 1.7-6.8; P = .001), and LV systolic dysfunction was not (OR, 0.63; CI, 0.3 -1.2; P = .32)INTERPRETATION:
Right ventricular dysfunction is present in nearly half of studied septic patients and is associated with over threefold higher 28-day mortality.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Choque Séptico
/
Disfunção Ventricular Direita
/
Sepse
/
Cardiomiopatias
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Chest
Ano de publicação:
2021
Tipo de documento:
Article