Diagnostic and Therapeutic Impact of Critical Care Echocardiography in Patients Admitted in the Intensive Care Unit for Circulatory Or Respiratory Failure Report from an Expert Center

Purpose Critical Care Echocardiography (CCE) is now a major tool in assessments of ICU patients. We aimed to evaluate its clinical impact in patients admitted to the intensive care unit for acute respiratory failure (ARF) or shock. Methods We conducted a single-center retrospective observational study of all patients admitted between January 1th and December 31st 2019 for ARF or shock, who received CCE in the first 12 h of admission. The primary outcome was the therapeutic impact associated with CCE. Secondary outcomes included differences in therapeutic impact between ARF and shock patients, and between trans-thoracic (TTE) and trans-esophageal (TEE) CCE. Results 486 patients were potentially eligible, 109 were excluded because CCE was performed after 12 h or because of missing CCE report. 329 patients were analyzed, 31% with shock, 44% with ARF, 25% with both. TTE was performed in 71%, TEE in 29%. All TEE patients were invasively mechanically ventilated and 65% of invasively ventilated patients underwent TEE. No TEE-related complications were observed. CCE was followed with 363 therapeutic interventions in 231 (70%) patients within 2 h. The most common involved hemodynamic optimization in 193 patients (59%), including fluid expansion (129 patients, 39%), vasopressor initiation (39 patients, 12%), vasopressor dose adjustment (79 patients, 24%), inotrope initiation (15 patients, 4.5%), inotrope dose adjustment (5 patients), and others like cardioversion (4 patients) and veno-arterial ECMO implantation (3 patients). TEE patients were more likely to receive therapeutic changes, notably significantly more fluids (53% vs 34% p = 0.0014) and had more frequent vasopressor dose adjustments (64% vs 24% p < 0.001). Conclusions CCE was followed with therapeutic interventions in nearly 70% of patients admitted for ARF or shock, emphasizing its diagnostic value. Hemodynamic optimization was the primary intervention. We have not found any complications or adverse events of TEE in our cohort.