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. 2018 Dec 27:6:85.
doi: 10.1186/s40560-018-0351-3. eCollection 2018.

Impaired right ventricular ejection fraction after cardiac surgery is associated with a complicated ICU stay

Inge T Bootsma  1 , Thomas W L Scheeren  2 , Fellery de Lange  1   3 , Johannes Haenen  3 , Piet W Boonstra  4 , E Christaan Boerma  1
Affiliations

Impaired right ventricular ejection fraction after cardiac surgery is associated with a complicated ICU stay

Inge T Bootsma et al. J Intensive Care. .

Abstract

Background: Right ventricular (RV) dysfunction is a known risk factor for increased mortality in cardiac surgery. However, the association between RV performance and ICU morbidity is largely unknown.

Methods: We performed a single-centre, retrospective study including cardiac surgery patients equipped with a pulmonary artery catheter, enabling continuous right ventricular ejection fraction (RVEF) measurements. Primary endpoint of our study was ICU morbidity (as determined by ICU length of stay, duration of mechanical ventilation, usage of inotropic drugs and fluids, and kidney dysfunction) in relation to RVEF. Patients were divided into three groups according to their RVEF; < 20%, 20-30%, and > 30%.

Results: We included 1109 patients. Patients with a RVEF < 20% had a significantly longer stay in ICU, a longer duration of mechanical ventilation, higher fluid balance, a higher incidence of inotropic drug usage, and more increase in postoperative creatinine levels in comparison to the other subgroups. In a multivariate analysis, RVEF was independently associated with increased ICU length of stay (OR 0.934 CI 0.908-0.961, p < 0.001), prolonged duration of mechanical ventilation (OR 0.969, CI 0.942-0.998, p = 0.033), usage of inotropic drugs (OR 0.944, CI 0.917-0.971, p < 0.001), and increase in creatinine (OR 0.962, CI 0.934-0.991, p = 0.011).

Conclusions: A decreased RVEF is independently associated with a complicated ICU stay.

Keywords: Cardiac surgery; Intensive care; Morbidity; Pulmonary artery catheter; Right ventricle; Right ventricular function; Thermodilution.

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Conflict of interest statement

The study was approved by the local ethical and scientific committee (“regionale toetsingscommissie patiëntgebonden onderzoek”, registration number nWMO95), and the need for informed consent was waived in accordance with applicable laws.Non applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a Median and 10–90th percentile of length of stay ICU. b Median and 10–90th percentile of duration of mechanical ventilation
Fig. 2
Fig. 2
Relation between pressure (CVP or PAP) and volume (EDVi or RVEF)-derived variables. N = 1109. Mean values measured with a pulmonary artery catheter over the first 24 h of ICU admission. * indicates a significant correlation between variables. Abbreviations: CVP central venous pressure; PAP pulmonary artery pressure; EDVi end-diastolic volume index; RVEF right ventricular ejection fraction
Fig. 3
Fig. 3
Percentage of patients with a prolonged ICU stay (above) and prolonged mechanical ventilation (below) when separated in 4 different groups according to their LV performance, measured with transthoracic echocardiography preoperatively, and RV performance measured with pulmonary artery catheter postoperatively. * means a statistical difference among groups. Abbreviations: LV left ventricle; RV right ventricle; LVEF left ventricular ejection fraction; RVEF right ventricular ejection fraction; ICU intensive care unit
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