The following is a summary of “Comprehensive temporal analysis of right ventricular function and pulmonary hemodynamics in mechanically ventilated COVID-19 ARDS patients,” published in the February 2024 issue of Critical Care by Tsolaki et al.

Researchers conducted a retrospective analysis to assess how severe COVID-19 with acute respiratory distress syndrome (ARDS) impacts the function of the right ventricle (RV), a frequently affected chamber in these patients, and its correlation with survival rates.

They conducted a comprehensive echocardiographic study on mechanically ventilated COVID-19 ARDS patients, utilizing 2D and 3D echocardiography. Left ventricular (LV) systolic dysfunction was explained as ejection fraction (EF) below 40% or longitudinal strain (LS) exceeding -18%. RV dysfunction was identified if two of the following indices were present: fractional area change (FAC) below 35%, tricuspid annulus systolic plane excursion (TAPSE) less than 1.6 cm, RV EF below 44%, or RV LS exceeding -20%. RV afterload was evaluated using pulmonary artery systolic pressure (PASP), PASP/Velocity Time Integral in RV outflow tract (VTI _RVOT), and pulmonary acceleration time (PAcT). Right ventriculoarterial coupling (VAC _R) was assessed through the TAPSE/PASP ratio.

The results showed that RV dysfunction was prevalent among 69% of the 176 patients (RV–EF: 41.1 ± 1.3%; RV–FAC: 36.6 ± 0.9%, TAPSE: 20.4 ± 0.4mm, RV–LS:− 14.4 ± 0.4%), often accompanied by RV dilatation (RVEDA/LVEDA: 0.82 ± 0.02). Most patients exhibited increased RV afterload (PASP: 33 ± 1.1 mmHg, PAcT: 65.3 ± 1.5 ms, PASP/VTI _RVOT: 2.29 ± 0.1 mmHg/cm). VAC _R was measured at 0.8 ± 0.06 mm/mmHg. LV–EF < 40% was found in 11.9% (21/176), with a mean LV–EF of 57.8 ± 1.1%. LV–LS (− 13.3 ± 0.3%) revealed silent LV impairment in 87.5% of cases. Mild pericardial effusion was detected in 38% (70) of patients, more frequently in non-survivors (P<0.05). Survivors experienced significant improvements in respiratory physiology by the 10th ICU-day (PaO ₂/FiO₂: 231.2 ± 11.9 vs 120.2 ± 6.7 mmHg; PaCO₂: 43.1 ± 1.2 vs 53.9 ± 1.5 mmHg; C_RS: 42.6 ± 2.2 vs 27.8 ± 0.9 ml/cmH ₂O, all P<0.0001). Additionally, survivors showed significant decreases in RV afterload (PASP: 36.1 ± 2.4 to 20.1 ± 3 mmHg, P<0.0001; PASP/VTI _RVOT: 2.5 ± 1.4 to 1.1 ± 0.7, P<0.0001; PAcT: 61 ± 2.5 to 84.7 ± 2.4 ms, P<0.0001), accompanied by improvement in RV systolic function ( P=0.001, RVEF: 36.5 ± 2.9% to 46.6 ± 2.1%, P=0.001; RV–LS: − 13.6 ± 0.7% to − 16.7 ± 0.8%). Furthermore, RV dilation decreased in survivors (RVEDA/LVEDA: 0.8 ± 0.05 to 0.6 ± 0.03, P=0.001). Day-10 C_RS correlated with RV afterload (PASP/VTI _RVOT, r: 0.535, P<0.0001) and systolic function (RV–LS, r: 0.345, P=0.001). LV–LS on the 10th ICU day, along with ΔRV–LS and ΔPASP/RVOT_VTI, were associated with survival.

They concluded that in severe COVID-19 patients with ARDS, improved RV function and reduced workload at day 10 predicted better breathing and higher survival rates.

Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01241-1