Routine transthoracic echocardiography in a general Intensive Care Unit: An 18 month survey in 704 patients

The authors analyzed 704 transthoracic echocardiographic (TTE) examinations, performed routinely to all admitted patients to a general 16bed 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. ATTE 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. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.