Background
Methods
Study setting and population
Data
Clinical and laboratory data
Echocardiography
Feasibility and reproducibility
Outcomes
Statistical considerations
Results
All (n = 94) | Normal RVFWLS (≤ -20%) (n = 67) | Abnormal RVFWLS (> −20%) (n = 27) | p value | ||
---|---|---|---|---|---|
Age, years | 59 [53, 67.3] | 60 [54, 68] | 58 [50, 66] | 0.362§ | |
Male | 57 (60.6%) | 41 (61.2%) | 16 (59.3%) | 0.862* | |
BMI, kg/m2 | n (n missing) | 92 (2) 31.6 [29.5, 36.2] | 66 (1) 32.2 [30.0, 36.8] | 26 (1) 30.8 [28.0, 34.2] | 0.206§ |
Ethnicity | |||||
White | 82 (87.2%) | 60 (89.6%) | 22 (81.5%) | 0.231ω | |
Non-white | 12 (12.8%) | 7 (10.4%) | 5 (18.5%) | ||
Clinical frailty score | n (n missing) | 93(1) 2 [2, 3] | 66 (1) 2 [2, 3] | 27 (0) 2 [2, 3] | 0.369§ |
APACHE II score | n (n missing) | 89 (5) 16 [13, 19] | 63 (4) 16 [14, 19] | 26 (1) 14.5 [11, 18.25] | 0.103§ |
CCCC | n (n missing) | 87 (7) 10.3 (2.8) | 63 (4) 10.5 (2.6) | 24 (3) 9.7 (3.1) | 0.189η |
Comorbidities | |||||
Smoking | |||||
Non-smoker | 53 (56.4%) | 39 (58.2%) | 14 (51.9%) | 0.837* | |
Ex-smoker > 1 year | 34 (36.2%) | 23 (34.3%) | 11 (40.7%) | ||
Current or within 1 year | 7 (7.4%) | 5 (7.5%) | 2 (7.4%) | ||
Alcohol history | |||||
n (n missing) | 92 (2) | 65 (2) | 27 (0) | 0.945* | |
None | 33 (35.9%) | 24 (36.9%) | 9 (33.3%) | ||
Minimal | 45 (48.9%) | 32 (49.2%) | 13 (48.1%) | ||
Moderate | 6 (6.5%) | 4 (6.2%) | 2 (7.4%) | ||
Excess | 8 (8.7%) | 5 (7.7%) | 3 (11.1%) | ||
Hypertension | 30 (31.9%) | 22 (32.8%) | 8 (29.6%) | 0.763* | |
Coronary artery disease | 8 (8.5%) | 5 (7.5%) | 3 (11.1%) | 0.235* | |
Diabetes | 31 (33%) | 20 (29.9%) | 11 (40.7%) | 0.310* | |
Asthma | 12 (12.8%) | 7 (10.4%) | 5 (18.5%) | 0.316ω | |
COPD | 7 (7.4%) | 5 (7.5%) | 2 (7.4%) | 0.815* | |
Treatments before intubation | |||||
Intravenous corticosteroids | 62 (66%) | 43 (64.2%) | 19 (70.4%) | 0.567* | |
Non-invasive ventilation | 65 (69.1%) | 46 (68.7%) | 19 (70.4%) | 0.871* | |
High flow nasal oxygen | 50 (53.2%) | 35 (52.2%) | 15 (55.6%) | 0.771* | |
Awake self-proning | 46 (48.9%) | 31 (46.3%) | 15 (55.6%) | 0.415* | |
Acute comorbidities | |||||
New arrhythmias | 16 (17.0%) | 11 (16.4%) | 5 (18.5%) | 0.271* | |
Confirmed or suspected PTE | Radiologically confirmed Clinically suspected No Unknown | 4 (4.3%) 4 (4.3%) 84 (89.4%) 2 (2.1%) | 1 (1.5%) 4 (6.0%) 61 (91.0%) 1 (1.5%) | 3 (11.1%) 0 (0.0%) 23 (85.2%) 1 (3.7%) | 0.097* |
Acute coronary syndrome | 5 (5.3%) | 3 (4.5%) | 2 (7.4%) | 0.623ω | |
Requirement for RRT | 14 (14.9%) | 8 (11.9%) | 6 (22.2%) | 0.117* | |
Requirement for prone invasive ventilation | 61 (64.9%) | 43 (64.2%) | 18 (66.7%) | 0.745* |
Feasibility and reproducibility
RVFWLS analysis and other echocardiography parameters
Echocardiography parameter | All (n = 94) | Normal RVFWLS (≤−20%) (n = 67) | Abnormal RVFWLS (> −20%) (n = 27) | p value | |
---|---|---|---|---|---|
Time from symptom onset to echocardiography (days) | n (n missing) | 93 (1) 18 [13.5, 22] | 67 (0) 18 [13, 21] | 26 (1) 21 [16, 27.5] | 0.011§ |
Time from intubation to echocardiography (days) | 5 [4, 8] | 5 [4, 8] | 5 [3, 9] | 0.794 § | |
RV4CSL % | −20.3 (4.4) | −22.5 (3.1) | −15.3 (2.3) | < 0.001η | |
RVFAC % | 34.1 [26.2, 38.5] | 36.0 (6.9) | 25.6 (6.1) | < 0.001η | |
TAPSE mm | n (n missing) | 45 (49) 23.7 [20.3, 25.5] | 32 (35) 24.1 (2.9) | 13 (14) 19.1 (4.6) | 0.002η |
S’ cm/s | n (n missing) | 42 (52) 15.2 (3.4) | 28 (39) 16.5 (2.7) | 14 (13) 12.6 (3.3) | < 0.001η |
RIMP | n (n missing) | 38 (56) 0.42 [0.30, 0.54] | 25 (42) 0.38 [0.3, 0.43] | 13 (14) 0.62 [0.53, 0.87] | < 0.001§ |
LVEI Diastole | n (n missing) | 51 (43) 1.04 [0.95, 1.54] | 35 (32) 1.07 (0.23) | 16 (11) 1.12 (0.27) | 0.449η |
LVEI Systole | n (n missing) | 52 (42) 1.04 [0.94, 1.18] | 36 (31) 1.06 (0.19) | 16 (11) 1.09 (0.26) | 0.653η |
RV:LV Basal Diameter ED | n (n missing) | 56 (38) 0.84 (0.13) | 39 (28) 0.82 (0.12) | 17 (10) 0.87 (0.13) | 0.167η |
Severe RV dilation (RV:LV > 1:1) | n (n missing) | 90 (4) 23 (25.6%) | 66 (1) 15 (22.7%) | 24 (3) 8 (33.3%) | 0.308* |
Septal flattening | n (n missing) | 90 (4) 9 (10%) | 66 (1) 4 (6.1%) | 24 (3) 5 (20.8%) | 0.053ω |
Severe ACP (severe RV dilation and septal flattening) | n (n missing) | 89 (5) 7 (7.9%) | 65 (2) 3 (4.6%) | 24 (3) 4 (16.7%) | 0.082ω |
Subjective RV dysfunctionA | n (n missing) | 93 (1) 16 (17.2%) | 67 (0) 7 (10.4%) | 26 (1) 9 (34.6%) | 0.012ω |
Subjective LV dysfunctionA | n (n missing) | 92 (2) 11 (12%) | 66 (1) 8 (12.1%) | 26 (1) 3 (11.5%) | > 0.999ω |
Patient characteristics
All (n = 94) | Normal RVFWLS (≤−20%) (n = 67) | Abnormal RVFWLS (> −20%) (n = 27) | p value | ||
---|---|---|---|---|---|
SOFA score | n (n missing) | 93 (1) 8 [6, 10] | 67 (0) 7 [6, 10] | 26 (1) 9 [7, 10] | 0.130§ |
Requirement for RRT on day of ECHO | 12 (12.8%) | 6 (9.0%) | 6 (22.2%) | 0.056* | |
Cardiac biomarkers | |||||
hsTn I, ng/L | n (n missing) | 57 (37) 13 [5, 39.5] | 43 (24) 9 [4, 23] | 14 (13) 39.5 [9, 146] | 0.032§ |
hsTn T, ng/L | n (n missing) | 35 (59) 18 [10, 29] | 22 (45) 12.5 [9.3, 19.8] | 13 (14) 27 [21.5, 47] | < 0.001§ |
Abnormal troponinA | n (n missing) | 92 (2) 41 (44.6%) | 65 (2) 21 (32.3%) | 27 (0) 20 (74.1%) | < 0.001* |
NT-proBNP, ng/L | n (n missing) | 84 (10) 461 [109, 1798] | 58 (9) 377 [165, 947] | 26 (1) 1697 [302, 23271] | 0.004§ |
Abnormal NT-proBNPB | n (n missing) | 84 (10) 53 (63.1%) | 58 (9) 33 (56.9%) | 26 (1) 20 (76.9%) | 0.079* |
Haemodynamic Parameters | |||||
HR, bpm | n (n missing) | 92 (2) 79 [65, 96] | 67 (0) 77 [63, 95] | 25 (2) 84 [74, 99] | 0.028§ |
Rhythm | n (n missing) Sinus AF/Flutter | 92 (2) 88 (95.7%) 4 (4.3%) | 67 (0) 64 (95.5%) 3 (4.5%) | 25 (2) 24 (96%) 1 (4%) | 0.703ω |
Mean BP, mmHg | n (n missing) | 89 (5) 77 [71, 87] | 64 (3) 79 [72, 88] | 25 (2) 76 [69, 86] | 0.164§ |
CVP, mmHg | n (n missing) | 59 (35) 7 [3, 12] | 45 (22) 7 [2.5, 12] | 14 (13) 8.5 [4.5, 12.5] | 0.485§ |
Drug Administration | |||||
Vasopressors | 40 (42.6%) | 23 (34.3%) | 17 (63%) | 0.011* | |
Inotropes | 0 (0%) | 0 (0%) | 0 (0%) | NA | |
Anticoagulation | |||||
Prophylactic | 81 (86.2%) | 61 (91%) | 20 (74.1%) | 0.097* | |
Therapeutic | 11 (11.7%) | 5 (7.5%) | 6 (22.2%) | ||
None | 2 (2.1%) | 1 (1.5%) | 1 (3.7%) | ||
Paralysis | 47 (50%) | 34 (50.7%) | 13 (48.1%) | 0.285* | |
Ventilation | |||||
FiO2 | 0.55 [0.45, 0.7] | 0.5 [0.45, 0.65] | 0.55 [0.45, 0.8] | 0.373§ | |
Requirement for prone ventilation in previous 24 h | 35 (37.2%) | 27 (40.3%) | 8 (29.6%) | 0.484* | |
Plateau pressure, cmH2O | n (n missing) | 48 (46) 25 (5.3) | 34 (33) 24.6 (5.6) | 14 (13) 26.1 (4.7) | 0.397η |
PAP, cmH2O | n (n missing) | 91 (3) 26 [19, 30] | 65 (2) 25 [19, 29] | 26 (1) 27 [20, 31] | 0.185§ |
Tidal volume, ml/kg (PBW) | n (n missing) | 89 (5) 6.6 [5.9, 7.3] | 64 (3) 6.5 [5.9, 7.2] | 25 (2) 7.0 [5.9, 7.5] | 0.335§ |
P/F ratio | n (n missing) | 93 (1) 17.5 [12.9, 21.9] | 67 (0) 17.5 [13.3, 21.8] | 26 (1) 17.8 [12.3, 22,5] | 0.918§ |
PEEP, cmH2O | n (n missing) | 93 (1) 10 [8, 12] | 66 (1) 10 [8, 12] | 27 (0) 10 [6, 10] | 0.110§ |
Respiratory rate (/minute) | 25 [21, 28] | 24.6 (5.0) | 24.4 (5.7) | 0.887η | |
Driving pressure, cmH2O | n (n missing) | 48 (46) 13 [11 17.75] | 34 (33) 12 [10, 16.25] | 14 (13) 16.5 [12, 20] | 0.040§ |
Dynamic compliance, ml/cmH2O | n (n missing) | 48 (46) 28.1 [19.1, 39.7] | 34 (33) 31.2 [21.6, 40.1] | 14 (13) 21.2 [16.5, 35.1] | 0.071§ |
Murray lung injury score | n (n missing) | 82 (12) 2.8 [2.3, 3] | 58 (9) 2.8 [2.2, 3] | 24 (3) 2.8 [2.35, 3.2] | 0.479§ |
Outcomes and survival analysis
All (n = 94) | Normal RVFWLS (≤ −20%) (n = 67) | Abnormal RVFWLS (> −20%) (n = 27) | p value | |
---|---|---|---|---|
Death | 39 (41.5%) | 23 (34.3%) | 16 (59.3%) | 0.026* |
RRT | 22 (23.4%) | 15 (22.4%) | 7 (25.9%) | 0.760* |
Prone ventilation | 42 (44.7%) | 32 (47.8%) | 10 (37%) | 0.578* |
Referral for ECMO | 12 (12.8%) | 9 (13.4%) | 3 (11.1%) | 0.280* |
Cox regression predicting 30-day mortality adjusting for remaining variables in table | ||
---|---|---|
HR (95% CI) | p value | |
Abnormal RVFWLS (> −20%) | 2.22 (1.14, 4.39) | 0.020 |
Age in years (per 1 year increase) | 1.06 (1.01, 1.10) | 0.009 |
Female Gender | 0.86 (0.44, 1.71) | 0.674 |
Non-white ethnicity | 1.00 (0.28, 3.60) | 0.994 |
APACHE II score on admission to ICU (per 1-score increase) | 1.06 (1.00, 1.11) | 0.040 |
Time from intubation to date of echo, in days (per 1 day increase) | 0.91 (0.81, 1.03) | 0.123 |