title: The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: an observational study.
abstract: OBJECTIVE
  Acute respiratory distress syndrome (ARDS) is associated with significant mortality and morbidity in survivors. Treatment is only supportive, therefore elucidating modifiable factors that could prevent ARDS could have a profound impact on outcome. The impact that sepsis-associated cardiac dysfunction has on ARDS is not known.
  
  
  METHODS
  In this retrospective observational cohort study of mechanically ventilated patients with severe sepsis and septic shock, 122 patients were assessed for the impact of sepsis-associated cardiac dysfunction on incidence of ARDS (primary outcome) and mortality.
  
  
  RESULTS
  Sepsis-associated cardiac dysfunction occurred in 44 patients (36.1%). There was no association of sepsis-associated cardiac dysfunction with ARDS incidence (p= 0.59) or mortality, and no association with outcomes in patients that did progress to ARDS after admission. Multivariable logistic regression demonstrated that higher BMI was associated with progression to ARDS (adjusted OR 11.84, 95% CI 1.24 to 113.0, p= 0.02).
  
  
  CONCLUSIONS
  Cardiac dysfunction in mechanically ventilated patients with sepsis did not impact ARDS incidence, clinical outcome in ARDS patients, or mortality. This contrasts against previous investigations demonstrating an influence of nonpulmonary organ dysfunction on outcome in ARDS. Given the frequency of ARDS as a sequela of sepsis, the impact of cardiac dysfunction on outcome should be further studied.
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO. Electronic address: fullerb@wusm.wustl.edu.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.affiliation: Department of Emergency Medicine, Department of Anesthesiology, Division of Critical Care, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Mohr
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Division of Cardiothoracic Anesthesiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Graetz
authors.affiliation: Department of Anesthesiology, Division of Critical Care, Division of Cardiothoracic Anesthesiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Isaac P
authors.initials: IP
authors.lastname: Lynch
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Matthew
authors.initials: M
authors.lastname: Dettmer
authors.affiliation: Division of Emergency Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Kevin
authors.initials: K
authors.lastname: Cullison
authors.affiliation: Saint Louis University School of Medicine, St Louis, MO.
authors.forename: Talia
authors.initials: T
authors.lastname: Coney
authors.affiliation: Saint Louis University School of Medicine, St Louis, MO.
authors.forename: Swetha
authors.initials: S
authors.lastname: Gogineni
authors.affiliation: Southern Illinois University School of Medicine, Springfield, IL.
authors.forename: Robert
authors.initials: R
authors.lastname: Gregory
mesh_terms: D000208:Acute Disease; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications*; D012772:Shock, Septic / Q000150:complications
keywords: Acute respiratory distress syndrome; Cardiac dysfunction; Sepsis