Assessing Right Ventricular Performance During Prone Ventilation in ARDS Patients Using Speckle Tracking Echocardiography

IF 1.4 4区医学 Q3 ACOUSTICS Journal of Clinical Ultrasound Pub Date : 2025-03-18 DOI:10.1002/jcu.23954

Issac Cheong, Federico Matías Álvarez Vilariño, Raúl Alejandro Gómez, Pablo Martín Merlo, Francisco Marcelo Tamagnone

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Abstract

Purpose

Acute respiratory distress syndrome (ARDS) frequently results in right ventricular (RV) dysfunction due to increased afterload and pulmonary vascular resistance. Among the standardized therapeutic strategies for ARDS management, protective ventilation and prone positioning in cases of severe oxygenation deterioration have proven effective, with prone positioning offering additional benefits, including improved RV function, enhanced physiological outcomes such as oxygenation and lung mechanics. This study aims to evaluate the impact of prone positioning on RV performance in ARDS patients using speckle tracking echocardiography (STE).

Methods

This observational, retrospective, single-center study aimed to evaluate the effects of prone positioning on RV function in patients with ARDS requiring mechanical ventilation. The study included patients with ARDS of varying severities who were passively ventilated. Transthoracic echocardiography was performed to assess RV function, with a specific focus on RV global longitudinal strain (GLS) and RV free wall strain (RVFWS) in both supine and prone positions using STE.

Results

Between August 2021 and April 2024, a total of 16 mechanically ventilated patients were included in the study. Regarding mechanical ventilation parameters, after applying the Bonferroni correction, there was a statistically significant increase in the PaO₂/FiO₂ ratio during the prone position (p = 0.004). Concerning echocardiographic variables, no statistically significant differences were found in left ventricular ejection fraction, basal RV diameter, RV/left ventricular end-diastolic area ratio, or the values of tricuspid annular tissue S′ wave, TAPSE, and RV fractional area change. However, during the prone position, there was a significant decrease in RV GLS (p = 0.009) and RVFWS (p = 0.003).

Conclusion

This study provides preliminary insights into the impact of the prone position maneuver on RV systolic function in patients with ARDS, suggesting that strain measured by STE could serve as a sensitive marker for detecting subclinical RV dysfunction. Further research with larger sample sizes and prospective designs is needed to confirm and build upon these findings.

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利用斑点跟踪超声心动图评估ARDS患者俯卧位通气时的右心室功能。

目的：急性呼吸窘迫综合征（ARDS）常因后负荷和肺血管阻力增加而导致右心室功能障碍。在ARDS管理的标准化治疗策略中，保护性通气和俯卧位在严重氧合恶化的情况下已被证明是有效的，俯卧位提供了额外的好处，包括改善RV功能，增强生理结果，如氧合和肺力学。本研究旨在利用斑点跟踪超声心动图（STE）评估俯卧位对ARDS患者右心室功能的影响。方法：本观察性、回顾性、单中心研究旨在评估俯卧位对需要机械通气的ARDS患者右心室功能的影响。该研究包括不同严重程度的ARDS患者，他们都是被动通气的。经胸超声心动图评估右心室功能，特别关注在仰卧位和俯卧位下右心室整体纵向应变（GLS）和右心室游离壁应变（RVFWS）。结果：2021年8月至2024年4月，共纳入16例机械通气患者。机械通气参数方面，经Bonferroni校正后，俯卧位时PaO2/FiO2比值升高有统计学意义（p = 0.004）。超声心动图变量方面，左室射血分数、左室基底直径、左室/左室舒张末期面积比、三尖瓣环状组织S波值、TAPSE值、左室分数面积变化无统计学差异。然而，俯卧位时，RV GLS （p = 0.009）和RVFWS （p = 0.003）显著降低。结论：本研究初步揭示了俯卧位对ARDS患者右心室收缩功能的影响，提示STE测量的应变可作为检测亚临床右心室功能障碍的敏感指标。进一步的研究需要更大的样本量和前瞻性设计来证实和建立这些发现。

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来源期刊

Journal of Clinical Ultrasound 医学-核医学

CiteScore

1.90

自引率

0.00%

发文量

248

审稿时长

6 months

期刊介绍： The Journal of Clinical Ultrasound (JCU) is an international journal dedicated to the worldwide dissemination of scientific information on diagnostic and therapeutic applications of medical sonography. The scope of the journal includes--but is not limited to--the following areas: sonography of the gastrointestinal tract, genitourinary tract, vascular system, nervous system, head and neck, chest, breast, musculoskeletal system, and other superficial structures; Doppler applications; obstetric and pediatric applications; and interventional sonography. Studies comparing sonography with other imaging modalities are encouraged, as are studies evaluating the economic impact of sonography. Also within the journal''s scope are innovations and improvements in instrumentation and examination techniques and the use of contrast agents. JCU publishes original research articles, case reports, pictorial essays, technical notes, and letters to the editor. The journal is also dedicated to being an educational resource for its readers, through the publication of review articles and various scientific contributions from members of the editorial board and other world-renowned experts in sonography.