Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Paciente Crítico, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile.
J Crit Care. 2022 Dec;72:154166. doi: 10.1016/j.jcrc.2022.154166. Epub 2022 Oct 13.
To evaluate cardiac function in mechanically ventilated patients with COVID-19.
Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS requiring mechanical ventilation admitted between April and July 2020 were included. We performed systematic transthoracic echocardiography assessing right and left ventricular function within 24 h of intubation.
140 patients aged 57 ± 11, 29% female were included. Cardiac output was 5.1 L/min [IQR 4.5-6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation out of whom 20 patients (14%) exhibited acute cor pulmonale (ACP). Eight out of the twenty patients with ACP exhibited pulmonary embolism (40%). Thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction <45%). In the multivariate analysis acute cor pulmonale and PaO/FiO ratio were independent predictors of ICU mortality.
Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. Acute cor pulmonale was associated with reduced pulmonary function and, in only 40% of patients, with co-existing pulmonary embolism. Acute cor pulmonale is an independent risk factor for ICU mortality.
评估 COVID-19 机械通气患者的心脏功能。
这是一项在智利四家大学附属医院进行的前瞻性、横断面多中心研究。所有连续的 COVID-19 急性呼吸窘迫综合征（ARDS）需要机械通气的患者，均在 2020 年 4 月至 7 月期间被纳入。我们在插管后 24 小时内进行了系统的经胸超声心动图检查，评估右心室和左心室功能。
共纳入 140 名年龄 57±11 岁的患者，其中 29%为女性。心输出量为 5.1L/min[IQR 4.5-6.2]，86%的患者需要去甲肾上腺素。ICU 死亡率为 29%（40 名患者）。54 名患者（39%）出现右心室扩张，其中 20 名患者（14%）出现急性肺心病（ACP）。20 名患有 ACP 的患者中有 8 名（40%）出现肺栓塞。13 名患者（9%）出现左心室收缩功能障碍（射血分数<45%）。在多变量分析中，急性肺心病和 PaO/FiO 比值是 ICU 死亡率的独立预测因素。
COVID-19 机械通气 ARDS 患者中右心室扩张非常常见。急性肺心病与肺功能下降相关，而在仅 40%的患者中，与同时存在的肺栓塞相关。急性肺心病是 ICU 死亡率的独立危险因素。
