The prognostic value of cardiac dysfunction assessed by bedside echocardiography in critically ill patients with COPD requiring mechanical ventilation: a study protocol

Zhongheng Zhang, Lin Chen, Kun Chen, Hongying Ni, Zhongheng Zhang, Lin Chen, Kun Chen, Hongying Ni

Abstract

Introduction: Chronic obstructive lung disease is not only a major cause of morbidity and mortality, but is also the major reason for intensive care unit (ICU) admission. Cardiac function is often impaired in this disease, but its association with clinical outcome has not been fully established.

Methods and analysis: This is a prospective observational study conducted in a 47-bed mixed ICU of a tertiary academic teaching hospital. The study will be performed from January 2014 to December 2015. All patients meeting the diagnostic criteria of acute exacerbation of chronic obstructive pulmonary disease and admitted to the ICU are potentially eligible for the present study. The relevant demographics and laboratory measurements have been obtained. Transthoracic echocardiography was performed immediately after ICU admission by experienced intensivists. The Cox proportional hazard regression model has been fitted by using a stepwise forward selection and backward elimination technique. If linear assumption is not satisfied, the linear spline function will be used.

Ethics and dissemination: The study protocol was approved by the ethics committee of Jinhua municipal central hospital. The results will be published in a peer-reviewed journal and shared with the worldwide medical community.

Trial registration number: The study protocol is registered at ClinicalTrials.gov (NCT02099279).

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References

    1. Menezes AM, Perez-Padilla R, Jardim JR, et al. . Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005;366:1875–81
    1. Menezes AM, Perez-Padilla R, Hallal PC, et al. . Worldwide burden of COPD in high- and low-income countries. Part II. Burden of chronic obstructive lung disease in Latin America: the PLATINO study. Int J Tuberc Lung Dis 2008;12:709–12
    1. Lopez AD, Mathers CD. Measuring the global burden of disease and epidemiological transitions: 2002–2030. Ann Trop Med Parasitol 2006;100:481–99
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
    1. Singanayagam A, Schembri S, Chalmers JD. Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease. Ann Am Thorac Soc 2013;10:81–9
    1. Grasso S, Leone A, De Michele M, et al. . Use of N-terminal pro-brain natriuretic peptide to detect acute cardiac dysfunction during weaning failure in difficult-to-wean patients with chronic obstructive pulmonary disease. Crit Care Med 2007;35:96–105
    1. Mekontso-Dessap A, de Prost N, Girou E, et al. . B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 2006;32:1529–36
    1. Ma G, Liao W, Qiu J, et al. . N-terminal prohormone B-type natriuretic peptide and weaning outcome in postoperative patients with pulmonary complications. J Int Med Res 2013;41:1612–21
    1. Zapata L, Vera P, Roglan A, et al. . B-type natriuretic peptides for prediction and diagnosis of weaning failure from cardiac origin. Intensive Care Med 2011;37:477–85
    1. Lara TM, Hajjar LA, de Almeida JP, et al. . High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery. Clinics (Sao Paulo) 2013;68:33–8
    1. Moschietto S, Doyen D, Grech L, et al. . 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 2012;16:R81.
    1. Papanikolaou J, Makris D, Saranteas T, et al. . New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player. Intensive Care Med 2011;37:1976–85.
    1. Zhang Z, Xu X, Ni H, et al. . Red cell distribution width is associated with hospital mortality in unselected critically ill patients. J Thorac Dis 2013;5:730–6
    1. Hurst JR, Wedzicha JA. Chronic obstructive pulmonary disease: the clinical management of an acute exacerbation. Postgrad Med J 2004;80:497–505
    1. MacIntyre NR, Cook DJ, Ely EW Jr, et al. . Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care Medicine. Chest 2001;120(6 Suppl):375S–95S
    1. Esteban A, Alia I, Gordo F, et al. . Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med 1997;156(2 Pt 1):459–65
    1. Lang RM, Bierig M, Devereux RB, et al. . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440–63
    1. Pollick C, Pittman M, Filly K, et al. . Mitral and aortic valve orifice area in normal subjects and in patients with congestive cardiomyopathy: determination by two dimensional echocardiography. Am J Cardiol 1982;49:1191–6
    1. Weekes AJ, Reddy A, Lewis MR, et al. . E-point septal separation compared to fractional shortening measurements of systolic function in emergency department patients: prospective randomized study. J Ultrasound Med 2012;31:1891–7
    1. Arques S, Roux E, Luccioni R. Current clinical applications of spectral tissue Doppler echocardiography (E/E′ ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. Cardiovasc Ultrasound 2007;5:16.
    1. Kim MK, Kim B, Lee JY, et al. . Tissue Doppler-derived E/e′ ratio as a parameter for assessing diastolic heart failure and as a predictor of mortality in patients with chronic kidney disease. Korean J Intern Med 2013;28:35–44
    1. Sharp AS, Tapp RJ, Thom SA, et al. . Tissue Doppler E/E′ ratio is a powerful predictor of primary cardiac events in a hypertensive population: an ASCOT substudy. Eur Heart J 2010;31:747–52
    1. Nagueh SF, Kopelen HA, Quinones MA. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation 1996;94:2138–45
    1. Douglas PS, Khandheria B, Stainback RF, et al. . ACCF/ASE/ACEP/ASNC/SCAI/SCCT/SCMR 2007 appropriateness criteria for transthoracic and transesophageal echocardiography: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American Society of Echocardiography, American College of Emergency Physicians, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society for Cardiovascular Magnetic Resonance endorsed by the American College of Chest Physicians and the Society of Critical Care Medicine. J Am Soc Echocardiogr 2007;50:187–204
    1. Jue J, Chung W, Schiller NB. Does inferior vena cava size predict right atrial pressures in patients receiving mechanical ventilation? J Am Soc Echocardiogr 1992;5:613–19
    1. Citro R, Rigo F, Ciampi Q, et al. . Echocardiographic assessment of regional left ventricular wall motion abnormalities in patients with tako-tsubo cardiomyopathy: comparison with anterior myocardial infarction. Eur J Echocardiogr 2011;12:542–9
    1. Cerqueira MD, Weissman NJ, Dilsizian V, et al. . Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 2002;105:539–42
    1. Lang RM, Bierig M, Devereux RB, et al. . Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440–63
    1. Schoenfeld DA Sample-size formula for the proportional-hazards regression model. Biometrics 1983;39:499–503
    1. Park SJ, Lee SC, Jang SY, et al. . E/e′ ratio is a strong prognostic predictor of mortality in patients with non-valvular atrial fibrillation with preserved left ventricular systolic function. Circ J 2011;75:2350–6
    1. Kruszewski K, Scott AE, Barclay JL, et al. . Noninvasive assessment of left ventricular filling pressure after acute myocardial infarction: a prospective study of the relative prognostic utility of clinical assessment, echocardiography, and B-type natriuretic peptide. Am Heart J 2010;159:47–54
    1. Schoenfeld D Partial residuals for the proportional hazards regression model. Biometrika 1982;69:239–41
    1. Wood GA, Jennings LS. On the use of spline functions for data smoothing. J Biomech 1979;12:477–9
    1. Lainscak M, Hodoscek LM, Dungen HD, et al. . The burden of chronic obstructive pulmonary disease in patients hospitalized with heart failure. Wien Klin Wochenschr 2009;121:309–13
    1. Curkendall SM, DeLuise C, Jones JK, et al. . Cardiovascular disease in patients with chronic obstructive pulmonary disease, saskatchewan Canada cardiovascular disease in COPD patients. Ann Epidemiol 2006;16:63–70
    1. Boussuges A, Pinet C, Molenat F, et al. . Left atrial and ventricular filling in chronic obstructive pulmonary disease. An echocardiographic and Doppler study. Am J Respir Crit Care Med 2000;162(2 Pt 1):670–5
    1. Sin DD, Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? The potential role of systemic inflammation in chronic obstructive pulmonary disease. Circulation 2003;107:1514–19
    1. Eickhoff P, Valipour A, Kiss D, et al. . Determinants of systemic vascular function in patients with stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2008;178:1211–18
    1. Hillis GS, Moller JE, Pellikka PA, et al. . Noninvasive estimation of left ventricular filling pressure by E/e′ is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol 2004;43:360–7
    1. Nagueh SF, Mikati I, Kopelen HA, et al. . Doppler estimation of left ventricular filling pressure in sinus tachycardia. a new application of tissue doppler imaging. Circulation 1998;98:1644–50
    1. Holland DJ, Prasad SB, Marwick TH. Prognostic implications of left ventricular filling pressure with exercise. Circ Cardiovasc Imaging 2010;3:149–56
    1. Beleslin BD, Ostojic M, Stepanovic J, et al. . Stress echocardiography in the detection of myocardial ischemia. Head- to-head comparison of exercise, dobutamine, and dipyridamole tests. Circulation 1994;90:1168–76
    1. De Boer RA, Pinto YM, Van Veldhuisen DJ. The imbalance between oxygen demand and supply as a potential mechanism in the pathophysiology of heart failure: the role of microvascular growth and abnormalities. Microcirculation 2003;10:113–26
    1. Celli BR, MacNee W, Agusti A, et al. . Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004;23:932–46

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