Abstract
Objective To preliminarily describe the epidemiologic and hemodynamic characteristics of critically ill patients with restrictive filling diastolic dysfunction based on echocardiography. Setting A retrospective study. Methods Epidemiologic characteristics of patients with restrictive filling diastolic dysfunction in ICU were described; clinical and hemodynamic data were preliminarily summarized and compared between patients with and without restrictive filling diastolic dysfunction; most of the data were based on echocardiography. Results More than half of the patients in ICU had diastolic dysfunction and about 16% of them had restrictive filling pattern. The patients who had restrictive filling diastolic dysfunction were more likely to have wider diameter of IVC (2.18 ± 0.50 versus 1.92 ± 0.43, P = 0.037), higher extravascular lung water score (15.9 ± 9.2 versus 13.2 ± 9.1, P = 0.014), lower left ventricular ejection fraction (EF-S: 53.0 ± 16.3 versus 59.3 ± 12.5, P = 0.014), and lower percentage of normal LAP that was estimated by E/e′ (8.9% versus 90.0%, P = 0.001) when compared with those of patients without restrictive filling diastolic dysfunction. Conclusion Our results suggest that critically ill patients with restrictive filling diastolic dysfunction may experience rising volume status, increasing extravascular lung water ultrasonic score, reducing long-axis systolic dysfunction, and less possibility of normal left atrial pressure. Intensivists are advised to pay more attention to patients with diastolic dysfunction, especially the exquisite fluid management of patients with restrictive filling pattern due to the close relationship of restrictive filling diastolic dysfunction with volume status and extravascular lung water in our study.
Highlights
Left ventricular diastolic dysfunction is quite common in critically ill patients [1,2,3,4] since there are so many predisposing factors existing, such as the complex medical history or underlying diseases, acute conditions, and special therapies in intensive care units
For the first time, we preliminarily described the epidemiologic and hemodynamic characteristics of critically ill patients with restrictive filling diastolic dysfunction based on echocardiography
We retrospectively reviewed the electronic medical record and the following data were recorded: age; gender; APACHE (Acute Physiology and Chronic Health Evaluation) II score; diagnosis; past medical history; heart rate, blood pressure and respiratory rate when performing critical care ultrasound examination; in-hospital mortality and 28-day mortality; and lengths of mechanical ventilation and staying in ICU; oxygenation index was calculated by dividing oxygen partial pressure, which was obtained through blood gas analysis performed within 24 h around critical care ultrasonic examination, by the corresponding oxygen concentration
Summary
Left ventricular diastolic dysfunction is quite common in critically ill patients [1,2,3,4] since there are so many predisposing factors existing, such as the complex medical history or underlying diseases (hypertension), acute conditions (sepsis, myocardial ischemia), and special therapies (volume loading, positive end-expiration pressure) in intensive care units. Since data [2, 4, 5] indicated that morbidity and mortality in patients with advanced diastolic heart failure are BioMed Research International as poor as in patients with systolic heart failure, diastolic dysfunction in critically ill patients has aroused more and more attention of intensivists. Saleh and Vieillard-Baron [13] pointed out that they still had little data from large studies regarding the incidence, characteristics, and impact on prognosis of left ventricular diastolic dysfunction in ICU
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