Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel

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Abstract

Background

The echocardiography working group of the European Society of Intensive Care Medicine recognized the need to provide structured guidance for future CCE research methodology and reporting based on a systematic appraisal of the current literature. Here is reported this systematic appraisal.

Methods

We conducted a systematic review, registered on the Prospero database. A total of 43 items of common interest to all echocardiography studies were initially listed by the experts, and other “topic-specific” items were separated into five main categories of interest (left ventricular systolic function, LVSF n = 15, right ventricular function, RVF n = 18, left ventricular diastolic function, LVDF n = 15, fluid management, FM n = 7, and advanced echocardiography techniques, AET n = 17). We evaluated the percentage of items reported per study and the fraction of studies reporting a single item.

Results

From January 2000 till December 2017 a total of 209 articles were included after systematic search and screening, 97 for LVSF, 48 for RVF, 51 for LVDF, 36 for FM and 24 for AET. Shock and ARDS were relatively common among LVSF articles (both around 15%) while ARDS comprised 25% of RVF articles. Transthoracic echocardiography was the main echocardiography mode, in 87% of the articles for AET topic, followed by 81% for FM, 78% for LVDF, 70% for LVSF and 63% for RVF. The percentage of items per study as well as the fraction of study reporting an item was low or very low, except for FM. As an illustration, the left ventricular size was only reported by 56% of studies in the LVSF topic, and half studies assessing RVF reported data on pulmonary artery systolic pressure.

Conclusion

This analysis confirmed sub-optimal reporting of several items listed by an expert panel. The analysis will help the experts in the development of guidelines for CCE study design and reporting.

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Most cited references 11

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American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography.

Paul Mayo, Yannick Beaulieu, Peter Doelken … (2009)

To define competence in critical care ultrasonography (CCUS). The statement is sponsored by the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Société de Réanimation de Langue Française (SRLF). The ACCP and the SRLF selected a panel of experts to review the field of CCUS and to develop a consensus statement on competence in CCUS. CCUS may be divided into general CCUS (thoracic, abdominal, and vascular), and echocardiography (basic and advanced). For each component part, the panel defined the specific skills that the intensivist should have to be competent in that aspect of CCUS. In defining a reasonable minimum standard for CCUS, the statement serves as a guide for the intensivist to follow in achieving proficiency in the field.

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Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation.

A Vieillard-Baron, M Matthay, J Teboul (2016)

Acute respiratory distress syndrome (ARDS) is frequently associated with hemodynamic instability which appears as the main factor associated with mortality. Shock is driven by pulmonary hypertension, deleterious effects of mechanical ventilation (MV) on right ventricular (RV) function, and associated-sepsis. Hemodynamic effects of ventilation are due to changes in pleural pressure (Ppl) and changes in transpulmonary pressure (TP). TP affects RV afterload, whereas changes in Ppl affect venous return. Tidal forces and positive end-expiratory pressure (PEEP) increase pulmonary vascular resistance (PVR) in direct proportion to their effects on mean airway pressure (mPaw). The acutely injured lung has a reduced capacity to accommodate flowing blood and increases of blood flow accentuate fluid filtration. The dynamics of vascular pressure may contribute to ventilator-induced injury (VILI). In order to optimize perfusion, improve gas exchange, and minimize VILI risk, monitoring hemodynamics is important.

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Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis

F Sanfilippo, C Corredor, N Fletcher … (2018)

Background Sepsis-induced myocardial dysfunction is associated with poor outcomes, but traditional measurements of systolic function such as left ventricular ejection fraction (LVEF) do not directly correlate with prognosis. Global longitudinal strain (GLS) utilizing speckle-tracking echocardiography (STE) could be a better marker of intrinsic left ventricular (LV) function, reflecting myocardial deformation rather than displacement and volume changes. We sought to investigate the prognostic value of GLS in patients with sepsis and/or septic shock. Methods We conducted a systematic review (PubMed and Embase up to 26 October 2017) and meta-analysis to investigate the association between GLS and mortality at longest follow up in patients with severe sepsis and/or septic shock. In the primary analysis, we included studies reporting transthoracic echocardiography data on GLS according to mortality. A secondary analysis evaluated the association between LVEF and mortality including data from studies reporting GLS. Results We included eight studies in the primary analysis with a total of 794 patients (survival 68%, n = 540). We found a significant association between worse LV function and GLS values and mortality: standard mean difference (SMD) − 0.26; 95% confidence interval (CI) − 0.47, − 0.04; p = 0.02 (low heterogeneity, I 2 = 43%). No significant association was found between LVEF and mortality in the same population of patients (eight studies; SMD, 0.02; 95% CI − 0.14, 0.17; p = 0.83; no heterogeneity, I 2 = 3%). Conclusions Worse GLS (less negative) values are associated with higher mortality in patients with severe sepsis or septic shock, while such association is not valid for LVEF. More critical care research is warranted to confirm the better ability of STE in demonstrating underlying intrinsic myocardial disease compared to LVEF. Electronic supplementary material The online version of this article (10.1186/s13054-018-2113-y) contains supplementary material, which is available to authorized users.

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Author and article information

Contributors

A. Vieillard-Baron: antoine.vieillard-baron@aphp.fr

Journal

Journal ID (nlm-ta): Ann Intensive Care

Journal ID (iso-abbrev): Ann Intensive Care

Title: Annals of Intensive Care

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2110-5820

Publication date (Electronic): 25 April 2020

Publication date PMC-release: 25 April 2020

Publication date Collection: 2020

Volume: 10

Electronic Location Identifier: 49

Affiliations

[1 ]GRID grid.1013.3, ISNI 0000 0004 1936 834X, Intensive Care Unit, Nepean Hospital, , The University of Sydney, ; Sydney, Australia

[2 ]GRID grid.412844.f, Department of Anesthesia and Intensive Care, , Policlinico-Vittorio Emanuele University Hospital, ; Catania, Italy

[3 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, Department of Intensive Care, Erasme University Hospital, , Univeristé Libre de Bruxelles, ; Brussels, Belgium

[4 ]GRID grid.411798.2, ISNI 0000 0000 9100 9940, Department of Anaesthesiology and Intensive Care, 1st Faculty of Medicine, , Charles University and General University Hospital, ; Prague, Czech Republic

[5 ]GRID grid.5640.7, ISNI 0000 0001 2162 9922, Department of Anaesthesiology and Intensive Care, Medical and Health Sciences, , Linköping University, ; Linköping, Sweden

[6 ]GRID grid.411083.f, ISNI 0000 0001 0675 8654, Department of Anaesthesiology and Critical Care Medicine, , Vall d’Hebron University Hospital, ; Barcelona, Spain

[7 ]GRID grid.416353.6, ISNI 0000 0000 9244 0345, Department of Perioperative Medicine, , Bart’s Heart Centre St. Bartholomew’s Hospital, ; W. Smithfield, London, UK

[8 ]GRID grid.4989.c, ISNI 0000 0001 2348 0746, CHIREC Hospitals, , Université Libre de Bruxelles, ; Brussels, Belgium

[9 ]GRID grid.264200.2, ISNI 0000 0000 8546 682X, Cardiothoracic Critical Care, St Georges Hospital, , St Georges University of London, ; London, UK

[10 ]GRID grid.50550.35, ISNI 0000 0001 2175 4109, Intensive Care Medicine Unit, Assistance Publique-Hôpitaux de Paris, , University Hospital Ambroise Paré, ; 92100 Boulogne-Billancourt, France

[11 ]GRID grid.12832.3a, ISNI 0000 0001 2323 0229, INSERM, UMR-1018, CESP, Team Kidney and Heart, , University of Versailles Saint-Quentin en Yvelines, ; Villejuif, France

[12 ]GRID grid.412116.1, ISNI 0000 0001 2292 1474, Service de réanimation médicale, , Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, ; 51 Avenue du Maréchal de Lattre de Tassigny, 94000 Créteil, France

[13 ]GRID grid.7841.a, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, , University of Rome, “La Sapienza,” Policlinico Umberto Primo, ; Viale del Policlinico, Rome, Italy

[14 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, Bodleian Health Care Libraries, , University of Oxford, ; Oxford, UK

[15 ]GRID grid.134996.0, ISNI 0000 0004 0593 702X, Medical Intensive Care Unit, , Amiens University Hospital, ; Amiens, France

[16 ]GRID grid.5012.6, ISNI 0000 0001 0481 6099, Department of Intensive Care, Maastricht University Medical Centre+, , University Maastricht, ; Maastricht, The Netherlands

[17 ]GRID grid.411178.a, ISNI 0000 0001 1486 4131, Medical-Surgical Intensive Care Unit, , Limoges University Hospital, Inserm CIC 1435, ; Limoges, France

[18 ]Division of Pulmonary, Critical Care and Sleep Medicine, Northwell Health LIJ/NSUH Medical Center, Zucker School of Medicine, Hofstra/Northwell, Hempstead, NY USA

Article

Publisher ID: 662

DOI: 10.1186/s13613-020-00662-y

PMC ID: 7183522

PubMed ID: 32335780

SO-VID: 0445f002-5523-4be8-9a20-d0f2169dfd06

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 29 October 2019

Date accepted : 11 April 2020

Custom metadata

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: guidelines,recommendations,intensive care,left ventricle,right ventricle,fluid management

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: guidelines, recommendations, intensive care, left ventricle, right ventricle, fluid management

Systematic review and literature appraisal on methodology of conducting and reporting critical-care echocardiography studies: a report from the European Society of Intensive Care Medicine PRICES expert panel

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Abstract

Background

Methods

Results

Conclusion

Related collections

Preventive and Emergency Medicine Insights

Most cited references 11

American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography.

Experts' opinion on management of hemodynamics in ARDS patients: focus on the effects of mechanical ventilation.

Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis

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