Right atrial strain during prone ventilation in acute respiratory distress syndrome

Abstract

, the blood pressure 150/70 mm Hg, the heart rate 80 beats per minute, his breathing labored and the oxygen saturation was 89% at rest while breathing ambient air. There was no peripheral edema. Chest radiography revealed bilateral ground glass opacities. His laboratory findings were unremarkable. The patient was admitted to the hospital and received prophylactic enoxaparin, remdesivir, dexamethasone, ceftriaxone and moxifloxacin on top of his regular medications. During his hospitalization in the ward, his hypoxemia worsened and after a failed trial of high flow ABSTRACT Although prone ventilation is widely used in acute respiratory distress syndrome (ARDS), its effects on right heart function, assessed by state-of-the-art echocardiography, are not well studied. We report the effect of prone ventilation on right atrial strain in severe ARDS after optimization of lung recruitment and hemodynamics using esophageal pressure and pulmonary artery catheter measurements, respectively. A 66-year-old obese man with ischemic heart failure was intubated due to ARDS. Before, during and after his first prone session, pulmonary, hemodynamic and echocardiographic (using two-dimensional transthoracic speckle tracking echocardiography) parameters were measured. Prone ventilation sustainably improved lung recruitment and right atrial strain. Combining detailed physiological and advanced echocardiographic assessment provides insights into the effect of prone ventilation in ARDS.