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VOLUME 28 , ISSUE 9 ( September, 2024 ) > List of Articles

Original Article

Prevalence of Diastolic Dysfunction in Critically Ill Patients Admitted to Intensive Care Unit from a Tertiary Care Hospital: A Prospective Observational Study

Bipin Luitel, Muthapillai Senthilnathan, Srinivasan Suganya, Prashant S Adole

Keywords : Critically ill adults, Impaired relaxation, Left ventricular diastolic dysfunction, Prevalence, 28-day mortality, Weaning failure

Citation Information : Luitel B, Senthilnathan M, Suganya S, Adole PS. Prevalence of Diastolic Dysfunction in Critically Ill Patients Admitted to Intensive Care Unit from a Tertiary Care Hospital: A Prospective Observational Study. Indian J Crit Care Med 2024; 28 (9):832-836.

DOI: 10.5005/jp-journals-10071-24794

License: CC BY-NC 4.0

Published Online: 31-08-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Aim: Critically ill individuals may have left ventricular diastolic dysfunction (LVDD) which can prolong their intensive care unit (ICU) stay. The purpose of this study was to determine the prevalence of LVDD in critically ill adult patients requiring mechanical ventilation in ICU, the effect of LVDD on 28-day survival, and weaning from mechanical ventilation. Methodology: A total of 227 adults who had been on mechanical ventilation for more than 48 hours in an ICU were recruited for this study. The study's parameters were recorded on the third day of mechanical ventilation using a low-frequency phased array probe. A simplified definition of LVDD in critically ill adults was utilized to determine the presence or absence of LVDD. Weaning failure and 28-day mortality were noted. Results: The prevalence of LVDD in adults requiring mechanical ventilation in the ICU was found to be 35.4% (n = 79). Patients with LVDD had the odds of having a 28-day mortality increase by 7.48 (95% CI: 3.24–17.26, p < 0.0001). Patients with LVDD had the odds of having weaning failure increase by 5.37 (95% CI: 2.17–13.26, p = 0.0003). Conclusion: Measures should be taken to detect critically ill adults with LVDD with systolic dysfunction or heart failure with preserved ejection fraction early so that their fluid balance, myocardial contractility, and afterload can be optimized to minimize their morbidity and mortality. Highlights: Critically ill adults with LVDD may have adverse outcomes. Hence, protocol should be in place for diagnosing LVDD early in critically ill adults thereby, measures can be taken to minimize morbidity in those patients.


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  1. Huygh J, Peeters Y, Bernards J, Malbrain MLNG. Hemodynamic monitoring in the critically ill: An overview of current cardiac output monitoring methods. F1000Research 2016;5. DOI: 10.12688/f1000research.8991.1.
  2. Kuznetsova T, Herbots L, López B, Jin Y, Richart T, Thijs L, et al. Prevalence of left ventricular diastolic dysfunction in a general population. Circ Heart Fail 2009;2:105–112. DOI: 10.1161/CIRCHEARTFAILURE.108.822627.
  3. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S, et al. Diastolic dysfunction and mortality in severe sepsis and septic shock. Eur Heart J 2012;33:895–903. DOI: 10.1093/eurheartj/ehr351.
  4. Bansal S, Varshney S, Shrivastava A. A prospective observational study to determine incidence and outcome of sepsis-induced cardiomyopathy in an intensive care unit. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med 2022;26:798–803. DOI: 10.5005/jp-journals-10071-24204.
  5. Gonzalez C, Begot E, Dalmay F, Pichon N, François B, Fedou AL, et al. Prognostic impact of left ventricular diastolic function in patients with septic shock. Ann Intensive Care 2016;6:36. DOI: 10.1186/s13613-016-0136-6.
  6. Mourad M, Chow-Chine L, Faucher M, Sannini A, Brun JP, de Guibert JM, et al. Early diastolic dysfunction is associated with intensive care unit mortality in cancer patients presenting with septic shock. Br J Anaesth 2014;112:102–109. DOI: 10.1093/bja/aet296.
  7. Papanikolaou J, Makris D, Saranteas T, Karakitsos D, Zintzaras E, Karabinis A, et al. New insights into weaning from mechanical ventilation: Left ventricular diastolic dysfunction is a key player. Intensive Care Med 2011;37:1976–1985. DOI: 10.1007/s00134-011-2368-0.
  8. Amarja H, Bhuvana K, Sriram S. Prospective observational study on evaluation of cardiac dysfunction induced during the weaning process. Indian J Crit Care Med Peer-Rev Off Publ Indian Soc Crit Care Med 2019;23:15–19. DOI: 10.5005/jp-journals-10071-23106.
  9. Moschietto S, Doyen D, Grech L, Dellamonica J, Hyvernat H, Bernardin G. Transthoracic echocardiography with Doppler tissue imaging predicts weaning failure from mechanical ventilation: Evolution of the left ventricle relaxation rate during a spontaneous breathing trial is the key factor in weaning outcome. Crit Care Lond Engl 2012;16:R81. DOI: 10.1186/cc11339.
  10. Sanfilippo F, Di Falco D, Noto A, Santonocito C, Morelli A, Bignami E, et al. Association of weaning failure from mechanical ventilation with transthoracic echocardiography parameters: A systematic review and meta-analysis. Br J Anaesth 2021;126:319–330. DOI: 10.1016/j.bja.2020.07.059.
  11. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr Off Publ Am Soc Echocardiogr 2016;29:277–314. DOI: 10.1016/j.echo.2016.01.011.
  12. Lanspa MJ, Gutsche AR, Wilson EL, Olsen TD, Hirshberg EL, Knox DB, et al. Application of a simplified definition of diastolic function in severe sepsis and septic shock. Crit Care Lond Engl 2016;20:243. DOI: 10.1186/s13054-016-1421-3.
  13. Rolando G, Espinoza EDV, Avid E, Welsh S, Pozo JD, Vazquez AR, et al. Prognostic value of ventricular diastolic dysfunction in patients with severe sepsis and septic shock. Rev Bras Ter Intensiva 2015;27:333–339. DOI: 10.5935/0103-507X.20150057.
  14. Cavefors O, Ljung Faxén U, Bech-Hanssen O, Lundin S, Ricksten SE, Redfors B, et al. Isolated diastolic dysfunction is associated with increased mortality in critically ill patients. J Crit Care 2023;76:154290. DOI: 10.1016/j.jcrc.2023.154290.
  15. Pulido JN, Afessa B, Masaki M, Yuasa T, Gillespie S, Herasevich V, et al. Clinical spectrum, frequency, and significance of myocardial dysfunction in severe sepsis and septic shock. Mayo Clin Proc 2012;87:620–628. DOI: 10.1016/j.mayocp.2012.01.018.
  16. Hong JY, Shin J, Kim WY. Impact of left ventricular dysfunction and fluid balance on the outcomes of patients with sepsis. Eur J Intern Med 2020;74:61–66. DOI: 10.1016/j.ejim.2019.11.019.
  17. Clancy DJ, Scully T, Slama M, Huang S, McLean AS, Orde SR. Application of updated guidelines on diastolic dysfunction in patients with severe sepsis and septic shock. Ann Intensive Care 2017;7:121. DOI: 10.1186/s13613-017-0342-x.
  18. Sturgess DJ, Marwick TH, Joyce C, Jenkins C, Jones M, Masci P, et al. Prediction of hospital outcome in septic shock: A prospective comparison of tissue Doppler and cardiac biomarkers. Crit Care Lond Engl 2010;14:R44. DOI: 10.1186/cc8931.
  19. Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022;145:e895–e1032. DOI: 10.1161/CIR.0000000000001063.
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