ABSTRACT
INTRODUCTION: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) and Stroke volume (SV) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. In the FRESH study, we have previously shown that patients who improve CO and SV exhibit improved outcome such as decreased mortality and decreased need for ventilation. The goal of this study was to explore the relationship between the change in stroke volume and cardiac output in patients with LV and RV Dysfunction. METHOD(S): The Starling Registry study is an observational registry study evaluating trends in CO and SV over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. RESULT(S): 71 patients with LV/RV dysfunction received hemodynamic monitoring during their stay across 4 units at 3 hospitals. 48% were female, and the average age was 68 years. 67% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, in this population of LV/ RV dysfunction, patients with COVID (p=0.016), pneumonia (p=0.034) and those that required oxygen treatment (p=0.034) were less likely to improve Cardiac Output following fluid challenge. CONCLUSION(S): Patients with LV/RV dysfunction represent a vulnerable population. We have previously shown the benefits of trending cardiac output and stroke volume in this patient population (ATS, 2018). Trends observed in this population may help indicate which patients may be at risk for more negative outcome.
ABSTRACT
Introduction: Cardiac function is known to be negatively impacted by sepsis. Monitoring Cardiac Output (CO) trends over the course of treatment may provide insight into cardiac function and may be used to predict patient outcome. The goal of this study was to explore the relationship between the change in stroke volume and outcome in critically ill patients. Methods: The Starling Registry study is an observational registry study evaluating trends in CO and SV (Stroke Volume) over time as related to patient outcome (NCT04648293). Patients that exhibited an overall improvement in CO (first CO measurement compared to last CO measurement) were compared to those who did not exhibit improvement. Results: A total of 229 critical care patients received hemodynamic monitoring during their ICU stay across three different hospitals. 48% were female, and the average age was 64 years. 64% of the patients had sepsis, and 17% of patients were positive for COVID. Notably, patients who exhibited an overall improvement in CO exhibited a decrease need for mechanical ventilation (4.8% vs 15%, p = 0.041) and a trend toward a decrease in mortality (16.4%) compared to those who did not improve (28.0%, p = 0.080) (Fig. 1). Conclusions: We have previously shown that patients who show an improvement in CO in response to the resuscitation exhibited improved outcome. Trending cardiac output over a 1-3 day monitoring period revealed additional usefulness in predicting patients with improved outcome. These results highlight the importance of trending hemodynamics in therapy. (Figure Presented).