Background Cardiac dysfunction is common in critical illness, yet conventional indices such as left ventricular ejection fraction (LVEF) may fail to detect early impairment. Mitral annular plane systolic excursion (MAPSE), a marker of longitudinal function, may provide prognostic information, but its role in critical illness remains uncertain. Methods PubMed, Embase, and Cochrane Library were searched for studies evaluating MAPSE in critically ill adults. Studies were included if MAPSE could be dichotomized using prespecified cutoffs (10 or 12 mm). The primary outcome was in-hospital mortality; secondary outcomes included 28–30-day mortality and exploratory measures of cardiac function and organ support. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled. Risk of bias was assessed with QUIPS and certainty of evidence with GRADE. Results Ten observational studies including 1313 patients were analyzed; 414 (31.5%) had reduced MAPSE. Most patients had sepsis or septic shock. Reduced MAPSE was associated with higher in-hospital mortality (37.7% vs 11.7%; RR 4.81; 95% CI 1.28–18.04; p = 0.02; I2 = 70.6%), with consistent effects across both cutoffs (p = 0.111) and adequate information size on trial sequential analysis. Reduced MAPSE was also associated with lower LVEF (MD −13.0%; 95% CI −20.6 to −5.4; p < 0.01; I2 = 94.6%), but not with 28–30-day mortality or exploratory outcomes. Certainty of evidence was low for in-hospital mortality and very low for secondary and exploratory outcomes. Conclusions Reduced MAPSE was associated with higher in-hospital mortality and may be a bedside marker of myocardial dysfunction. Given the limitations of the available evidence, MAPSE remains a hypothesis-generating marker requiring prospective validation.
Purpose Maintenance of systemic homeostasis and prevention of secondary injury are a cornerstone of treatment in neurocritical care to prevent organ dysfunction and adverse clinical outcome. This is a pilot descriptive and hypothesis generating study aiming to measure and characterize the incidence of systemic hypotension and hypoxemia occurring during the intensive care unit (ICU) stay in patients with catastrophic brain injury potentially evolving to brain death. Methods Adult patients admitted to ICU with catastrophic brain injury and Glasgow coma scale ≤5 have been enrolled. Arterial blood pressure and SpO2 were collected minute by minute from a central station connected to patients’ bedside monitors. Results We report on 24 patients recruited prospectively from the University Hospital of Messina, Italy as a part of a larger ongoing multi-centre study. Patient monitoring data ranged from 8-3000 hours (0.3-125 days). Admission diagnoses were intracerebral haemorrhage (N= 13), TBI (N=4), SAH (N=3), ischaemic stroke (N=3) and hypoxic encephalopathy (N=1). The proportion of valid monitoring time spent with secondary insults and the pressure time index (PTI) are presented and discussed. Day 3 and 4 demonstrated the largest number of secondary insults which were mainly hypotension. Patients who progressed to brain death (n = 9) or who died in ICU from cardiac complications (n = 7) exhibited a more severe and sustained hypotensive burden compared with patients alive at discharge (n = 8). This descriptive study proved useful for identifying an optimal window for tracking insults as well as piloting several key summary measures and visualisations which will be utilized in a larger multi-centre study. Conclusions In patients with catastrophic brain injury, the incidence of hypotension remains the highest among systemic secondary insults in patients progressing to brain death and cardiac death.
