The effectiveness of transthoracic echocardiography as a screening examination in a noncoronary intensive care unit

Introduction

The authors tested the feasibility of transthoracic echocardiography (TTE) as a routine technique in a medical/surgical ICU.

Methods

The study was carried out in a 16-bed noncoronary ICU during 18 months. For this purpose, a TTE was performed within the first 24 hours of admission. The issues addressed were: data acquisition possibilities, quantification of selected echocardiographic parameters (cardiac chamber dimensions, left ventricular function, cardiac output, and Doppler examination), detection of any structural echocardiographic alteration, as well as new severe conditions.

Results

In this study 704 consecutive patients were enrolled, with a mean age of 61.5 ± 17.5 years, an ICU stay of 10.6 ± 17.1 days, APACHE II score of 22.6 ± 8.9, and SAPS II of 52.7 ± 20.4. In four patients TTE could not be performed. The data are presented in Table 1. At least an echocardiographic alteration was detected in 234 (33%) patients. The most common alterations were left atrial enlargement (n = 163), and left ventricular dysfunction (n = 132). Patients with these alterations were older (66 ± 16.5 vs 58.1 ± 17.4 years, P < 0.001), presented a higher APACHE II score (24.4 ± 8.7 vs 21.1 ± 8.9, P < 0.001) and a higher mortality (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 left ventricular dysfunction. By multivariate logistic regression analysis, TTE parameters did not correlate with mortality or ICU stay. Mortality was related to ICU stay (CI 1.0–1.019, P < 0.001).

Table 1 (abstract P280)

Conclusion

We conclude that TTE is feasible in a noncoronary ICU, most parameters being obtained. A routine utilization of TTE detected 53 (7.5%) patients with severe unsuspected diseases.