Value of early critical care transthoracic echocardiography for patients undergoing mechanical ventilation: a retrospective study

Objectives To evaluate whether early intensive care transthoracic echocardiography (TTE) can improve the prognosis of patients with mechanical ventilation (MV). Design A retrospective cohort study. Setting Patients undergoing MV for more than 48 hours, based on the Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU-CRD), were selected. Participants 2931 and 6236 patients were recruited from the MIMIC-III database and the eICU database, respectively. Primary and secondary outcome measures The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality from the date of ICU admission, days free of MV and vasopressors 30 days after ICU admission, use of vasoactive drugs, total intravenous fluid and ventilator settings during the first day of MV. Results We used propensity score matching to analyse the association between early TTE and in-hospital mortality and sensitivity analysis, including the inverse probability weighting model and covariate balancing propensity score model, to ensure the robustness of our findings. The adjusted OR showed a favourable effect between the early TTE group and in-hospital mortality (MIMIC: OR 0.78; 95% CI 0.65 to 0.94, p=0.01; eICU-CRD: OR 0.76; 95% CI 0.67 to 0.86, p<0.01). Early TTE was also associated with 30-day mortality in the MIMIC database (OR 0.71, 95% CI 0.57 to 0.88, p=0.001). Furthermore, those who had early TTE had both more ventilation-free days (only in eICU-CRD: 23.48 vs 24.57, p<0.01) and more vasopressor-free days (MIMIC: 18.22 vs 20.64, p=0.005; eICU-CRD: 27.37 vs 28.59, p<0.001) than the control group (TTE applied outside of the early TTE and no TTE at all). Conclusions Early application of critical care TTE during MV is beneficial for improving in-hospital mortality. Further investigation with prospectively collected data is required to validate this relationship.

Automated summary

Early application of critical care transthoracic echocardiography (TTE) during mechanical ventilation (MV) was found to be beneficial for improving in-hospital mortality and other outcomes, based on a retrospective cohort study using data from the MIMIC-III and eICU databases. The adjusted odds ratio showed a favourable effect of early TTE on in-hospital mortality, 30-day mortality, and ventilation-free and vasopressor-free days. Further investigation with prospectively collected data is needed to confirm these findings.