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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | Septicemia | Research

Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients

Authors: Hongmin Zhang, Wei Huang, Qing Zhang, Xiukai Chen, Xiaoting Wang, Dawei Liu, Critical Care Ultrasound Study Group

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

Introduction

Right ventricle (RV) dilation in combination with elevated central venous pressure (CVP), which is a state of RV congestion, is seen as a sign of RV failure (RVF). On the other hand, RV systolic function is usually assessed by tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC). This study aimed to investigate the prevalence and prognostic value of RVF and RV systolic dysfunction (RVSD) in septic patients.

Methods

Mechanically ventilated sepsis and septic shock patients were included. We collected haemodynamic and echocardiographic parameters as well as prognostic information including mechanical ventilation duration, length of ICU stay and 30-day mortality. RVF was defined as a right and left ventricular end-diastolic area ratio ≥ 0.6 in combination with CVP ≥ 8 mmHg. RVSD was defined as TAPSE < 16 mm or FAC < 35%.

Results

A total of 215 patients were enrolled in this study, and the patients were divided into 4 groups: patients with normal RV function (normal, n = 101), patients with RVF but without RVSD (RVF only, n = 38), patients with RVSD but without RVF (RVSD only, n = 44), and patients with combined RVF–RVSD (RVF/RVSD, n = 32). The RVF/RVSD group and RVSD only group had a lower cardiac index than the RVF only group and normal groups (p < 0.05). At 30 days after ICU admission, 50.0% of patients had died in the RVF/RVSD group, which was much higher than the mortality in the RVF only group (13.2%) and normal group (13.9%) (p < 0.05). In a Cox regression analysis, the presence of RVF/RVSD was independently associated with 30-day mortality (HR 3.004, 95% CI:1.370–6.587, p = 0.006). In contrast, neither the presence of RVF only nor the presence of RVSD only was associated with 30-day mortality (HR 0.951, 95% CI:0.305–2.960, p = 0.931; HR 1.912, 95% CI:0.853–4.287, p = 0.116, respectively).

Conclusion

The presence of combined RVF–RVSD was associated with 30-day mortality in mechanically ventilated septic patients. Additional studies are needed to confirm and expand this finding.
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Metadata
Title
Prevalence and prognostic value of various types of right ventricular dysfunction in mechanically ventilated septic patients
Authors
Hongmin Zhang
Wei Huang
Qing Zhang
Xiukai Chen
Xiaoting Wang
Dawei Liu
Critical Care Ultrasound Study Group
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00902-9

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