title: Routine transthoracic echocardiography in a general Intensive Care Unit: an 18 month survey in 704 patients.
abstract: The authors analyzed 704 transthoracic echocardiographic (TTE) examinations, performed routinely to all admitted patients to a general 16-bed Intensive Care Unit (ICU) during an 18-month period. Data acquisition and prevalence of abnormalities of cardiac structures and function were assessed, as well as the new, previously unknown severe diagnoses. A TTE was performed within the first 24 h of admission on 704 consecutive patients, with a mean age of 61.5+/-17.5 years, ICU stay of 10.6+/-17.1 days, APACHE II 22.6+/-8.9, and SAPS II 52.7+/-20.4. In four patients, TTE could not be performed. Left ventricular (LV) dimensions were quantified in 689 (97.8%) patients, and LV function in 670 (95.2%) patients. Cardiac output (CO) was determined in 610 (86.7%), and mitral E/A in 399 (85.9% of patients in sinus rhythm). Echocardiographic abnormalities were detected in 234 (33%) patients, the most common being left atrial (LA) enlargement (n=163), and LV dysfunction (n=132). Patients with these alterations were older (66+/-16.5 vs 58.1+/-17.4, p<0.001), presented a higher APACHE II score (24.4+/-8.7 vs 21.1+/-8.9, p<0.001), and had a higher mortality rate (40.1% vs 25.4%, p<0.001). Severe, previously unknown echocardiographic diagnoses were detected in 53 (7.5%) patients; the most frequent condition was severe LV dysfunction. Through a multivariate logistic regression analysis, it was determined that mortality was affected by tricuspid regurgitation (p=0.016, CI 1.007-1.016) and ICU stay (p<0.001, CI 1-1.019). We conclude that TTE can detect most cardiac structures in a general ICU. One-third of the patients studied presented cardiac structural or functional alterations and 7.5% severe previously unknown diagnoses.
authors.affiliation: Intensive Care Unit, Hospital Curry Cabral, Lisbon, Portugal. p.marcelino@netcabo.pt
authors.forename: Paulo Alexandre
authors.initials: PA
authors.lastname: Marcelino
authors.forename: Susan Marques
authors.initials: SM
authors.lastname: Marum
authors.forename: Ana Paula Matos
authors.initials: AP
authors.lastname: Fernandes
authors.forename: Nuno
authors.initials: N
authors.lastname: Germano
authors.forename: Mario G
authors.initials: MG
authors.lastname: Lopes
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000401:mortality; D016638:Critical Illness / Q000401:mortality; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000401:mortality*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality; D055815:Young Adult