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Observational Study
. 2015 Feb;30(1):65-70.
doi: 10.1016/j.jcrc.2014.07.027. Epub 2014 Aug 7.

The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: an observational study

Brian M Fuller  1 , Nicholas M Mohr  2 , Thomas J Graetz  3 , Isaac P Lynch  3 , Matthew Dettmer  4 , Kevin Cullison  4 , Talia Coney  5 , Swetha Gogineni  5 , Robert Gregory  6
Affiliations
Observational Study

The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: an observational study

Brian M Fuller et al. J Crit Care. 2015 Feb.

Abstract

Purpose: Acute respiratory distress syndrome (ARDS) is associated with significant mortality and morbidity in survivors. Treatment is only supportive, therefore elucidating modifiable factors that could prevent ARDS could have a profound impact on outcome. The impact that sepsis-associated cardiac dysfunction has on ARDS is not known.

Materials and methods: In this retrospective observational cohort study of mechanically ventilated patients with severe sepsis and septic shock, 122 patients were assessed for the impact of sepsis-associated cardiac dysfunction on incidence of ARDS (primary outcome) and mortality.

Results: Sepsis-associated cardiac dysfunction occurred in 44 patients (36.1%). There was no association of sepsis-associated cardiac dysfunction with ARDS incidence (p= 0.59) or mortality, and no association with outcomes in patients that did progress to ARDS after admission. Multivariable logistic regression demonstrated that higher BMI was associated with progression to ARDS (adjusted OR 11.84, 95% CI 1.24 to 113.0, p= 0.02).

Conclusions: Cardiac dysfunction in mechanically ventilated patients with sepsis did not impact ARDS incidence, clinical outcome in ARDS patients, or mortality. This contrasts against previous investigations demonstrating an influence of nonpulmonary organ dysfunction on outcome in ARDS. Given the frequency of ARDS as a sequela of sepsis, the impact of cardiac dysfunction on outcome should be further studied.

Keywords: Acute respiratory distress syndrome; Cardiac dysfunction; Sepsis.

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Conflict of interest statement

Conflicts of interest:

All authors declare no conflicts of interest

Figures

Figure 1
Figure 1
Flow diagram depicting the patients analyzed to achieve each objective of the study. ARDS: acute respiratory distress syndrome; ED: emergency department.
Figure 2
Figure 2
demonstrates no association between the incidence of ARDS and ejection fraction.
See this image and copyright information in PMC

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