Unanticipated Critical Findings on Echocardiography in Septic Patients
Source: Ultrasound J (2020) 12:12
The use of echocardiography is to manage patients with sepsis has become routine. Transthoracic echocardiogram (TTE) is now considered appropriate in the management of patients in shock or situations where TTE is likely to change management. Currently, the application of echocardiography in septic patients is often related to hemodynamic management, especially fluid administration. However, screening and research echocardiograms may identify an unanticipated critical finding such as severe left or right ventricular dysfunction or pericardial tamponade and others.
The purpose of this study was to estimate how often unanticipated critical findings are identified in the echocardiograms of septic patients admitted to the ICU.
Patients admitted to the ICU with severe sepsis or septic shock older than 18 years who had an echocardiogram obtained within 24 h of admission were enrolled in the study. Exclusion criteria included known pregnancy, primary diagnosis of acute coronary syndrome or major cardiac dysrhythmia, or known alternative diagnosis for shock (trauma, anaphylaxis, hemorrhage).
All echocardiogram reports were reviewed to identify clinical findings. The authors defined whether the critical findings were anticipated or not based on a pre-determined algorithm.
393 septic patients were included in the study, of which 56% were in shock at the time of the echocardiogram. The mean APACHE II score for the cohort was 26 (SD = 10) and 28-day mortality was 24% (n = 93).
Unanticipated critical findings were identified in 5% of patients (n = 20). In total, 40 critical findings were identified on TTE in 38 (10%) patients (two patients had two critical findings). Of these 40 findings, 21 (53%) were unanticipated. An unanticipated critical finding was not significantly associated with 28-day mortality when adjusted for admission APACHE II (p = 0.27). A critical finding (whether anticipated or unanticipated) on echocardiogram was also not significantly associated with 28-day mortality when adjusted for admission APACHE II score.
The author concluded that unanticipated critical findings on routine echocardiograms in septic ICU patients are uncommon and that the potential relevance of echocardiography to sepsis management is more likely related to hemodynamic management than to traditional cardiologic diagnoses.