Effect of Focused Cardiac Ultrasound in Combination with Lung Ultrasound on Critically Ill Patients: A Multicenter Observational Study in China

Objective Focused cardiac ultrasound(FCU)and lung ultrasound(LU)are increasingly being used in critically ill patients.This study aimed to investigate the effect of FCU in combination with LU on these patients and to determine if the timing of ultrasound examination was associated with treatment change.Methods This is a multicenter cross-sectional observational study.Consecutive patients admitted to the intensive care unit(ICU)were screened for enrollment.FCU and LU were performed within the first 24 h,and treatment change was proposed by the performer based on the ultrasound results and other clinical conditions.Results Among the 992 patients included,502 were examined within 6 h of ICU admission(early phase group),and 490 were examined after 6 h of admission(later phase group).The early phase group and the later phase group had similar proportions of treatment change(48.8%vs.49.0%,χ^(2)=0.003,P=0.956).In the multivariable analysis,admission for respiratory failure was an independent variable associated with treatment change,with an odds ratio(OR)of 2.357[95%confidence interval(CI):1.284-4.326,P=0.006];the timing of examination was not associated with treatment change(OR=0.725,95%CI:0.407-1.291,P=0.275).Conclusions FCU in combination with LU,whether performed during the early phase or later phase,had a significant impact on the treatment of critically ill patients.Patients with respiratory failure were more likely to experience treatment change after the ultrasound examination.

重症超声应用及培训原则与质量控制标准

重症超声在重症医学相关领域的应用日益广泛, 已成为重症专业医生不可或缺的检查、评估与监测手段。但由于超声本身较强的操作者依赖性, 且很多医生未能接受规范的重症超声培训, 导致认识与应用水平参差不齐。因此, 规范重症超声培训及严格质量控制非常关键。为此制定了本标准, 以推动重症超声更好地发展。

Functional mitral regurgitation combined with increased early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio is associated with a poor prognosis in patients with shock

Background:Functional mitral regurgitation(FMR)is common in critically ill patients and may cause left atrial(LA)pressure elevation.This study aims to explore the prognostic impact of synergistic LA pressure elevation and FMR in patients with shock.Methods:We retrospectively screened 130 consecutive patients of 175 patients with shock from April 2016 to June 2017.The incidence and impact of FMR and early diastolic transmitral velocity to early mitral annulus diastolic velocity ratio(E/e’)≥4 within 6 h of shock on the prognosis of patients were evaluated.Finally,the synergistic effect of FMR and E/e’were assessed by combination,grouping,and trend analyses.Results:Forty-four patients(33.8%)had FMR,and 15 patients(11.5%)had E/e’elevation.A multivariate analysis revealed FMR and E/e’as independent correlated factors for 28-day mortality(P=0.043 and 0.028,respectively).The Kaplan-Meier survival analysis revealed a significant difference in survival between patients with and without FMR(χ2=7.672,P=0.006)and between the E/e’≥14 and E/e’<14 groups(χ2=19.351,P<0.010).Twenty-eight-day mortality was significantly different among the four groups(χ2=30.141,P<0.010).The risk of 28-day mortality was significantly higher in group 4(E/e’≥14 with FMR)compared with groups 1(E/e’<14 without FMR)and 2(E/e’<14 with FMR)(P=0.001 and 0.046,respectively).Conclusions:Patients with shock can be identified by the presence of FMR.FMR and E/e’are independent risk factors for a poor prognosis in these patients,and prognosis is worst when FMR and E/e’≥14 are present.It may be possible to improve prognosis by reducing LA pressure and E/e’.Trial Registration:ClinicalTrials.gov,NCT03082326.