Blank, Sebastiaan P; Blank, Ruth M

Author(s)

Blank, Sebastiaan P

Blank, Ruth M

Publication Date

2024-02-01

Abstract

OBJECTIVES: Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database. DESIGN: Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality. SETTING: Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019. PATIENTS: Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95-1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus. CONCLUSIONS: Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.

Affiliation

Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia.

Department of Anesthesia, Royal Darwin Hospital, Darwin, NT, Australia.

Citation

Crit Care Med. 2024 Feb 1;52(2):248-257. doi: 10.1097/CCM.0000000000006069. Epub 2023 Oct 20.

Pubmed ID

https://pubmed.ncbi.nlm.nih.gov/38240507/?otool=iaurydwlib

Link

https://hdl.handle.net/10137/12657

Volume

52

Subject

Adolescent

Adult

Humans

Critical Care

*Echocardiography

Intensive Care Units

Retrospective Studies

*Sepsis/diagnostic imaging/mortality/therapy

*Shock, Septic/diagnostic imaging/mortality/therapy

Title

Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.

Type of document

Journal Article

Entity Type

Publication

Author(s)	Blank, Sebastiaan P Blank, Ruth M
Publication Date	2024-02-01
Abstract	OBJECTIVES: Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database. DESIGN: Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality. SETTING: Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019. PATIENTS: Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95-1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus. CONCLUSIONS: Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.
Affiliation	Intensive Care Unit, Royal Darwin Hospital, Darwin, NT, Australia. Department of Anesthesia, Royal Darwin Hospital, Darwin, NT, Australia.
Citation	Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Crit Care Med. 2024 Feb 1;52(2):248-257. doi: 10.1097/CCM.0000000000006069. Epub 2023 Oct 20.
Pubmed ID	https://pubmed.ncbi.nlm.nih.gov/38240507/?otool=iaurydwlib
Link	https://hdl.handle.net/10137/12657
Volume	52
Subject	Adolescent Adult Humans Critical Care Echocardiography Intensive Care Units Retrospective Studies Sepsis/diagnostic imaging/mortality/therapy *Shock, Septic/diagnostic imaging/mortality/therapy
Title	Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.
Type of document	Journal Article
Entity Type	Publication

Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset.

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