Satapathy Himanshu, Ahmed Asif, Joshi Sujeet A, Sehgal Lalit, Dhar Sanjib K
Critical Care Medicine, Sum Ultimate Medicare, Bhubaneswar, IND.
Critical Care Medicine, Tata Main Hospital, Jamshedpur, IND.
Cureus. 2025 Jan 3;17(1):e76868. doi: 10.7759/cureus.76868. eCollection 2025 Jan.
Background Right ventricular (RV) dysfunction is a typical complication of acute respiratory distress syndrome (ARDS), which is an independent predictor of poor prognosis in ARDS. Thus, evaluation of RV function is a crucial component of ARDS patient management. The present study aimed to determine the incidence of RV dysfunction by 2D echocardiography in mechanically ventilated ARDS patients in the ICU and assess the serial changes in tricuspid annular plane systolic excursion (TAPSE) among these patients in the intensive care unit (ICU) of a tertiary care cancer institute of Eastern India. Methods The prospective observational study included 40 patients aged 18-80 years who were admitted to the critical care unit with ARDS and put on mechanical ventilation. Patients meeting eligibility criteria underwent routine investigations on admission to the ICU. Key parameters included recording of the partial pressure of oxygen/fraction of inspired oxygen (PaO/FiO) oxygenation index, TAPSE on 2D transthoracic echocardiography, and plasma B-type (or brain) natriuretic peptide (BNP) level estimation conducted on day 0, day 2, and day 5. A TAPSE value <17 mm was considered to indicate RV dysfunction. Weaning outcomes, ventilator days, length of ICU stay, length of hospital stay, and in-ICU mortality were noted. Results Among the 40 study participants, the mean (± SD) age was 52.6 (± 14.3) years, and 52.5% were male patients. The incidence of RV dysfunction in ARDS was 17.5%. These patients were observed to have a progressive worsening of hypoxia along with a significant elevation of plasma BNP levels on day 2 and day 5 as compared to baseline. Weaning outcomes, ventilator days, length of hospital stay, and in-ICU mortality were comparable between the two groups. Conclusion The present study reports a 17.5% incidence of RV dysfunction in ARDS and quantifies a longitudinal deterioration in RV function with the onset of ARDS using TAPSE. The inclusion of objective indices on two-dimensional echocardiography, such as TAPSE, facilitates their regular application at the bedside and equips clinicians with a means to detect and quantify RV dysfunction in its early stages in ARDS.
背景 右心室（RV）功能障碍是急性呼吸窘迫综合征（ARDS）的典型并发症，是ARDS患者预后不良的独立预测因素。因此，评估RV功能是ARDS患者管理的关键组成部分。本研究旨在通过二维超声心动图确定印度东部一家三级护理癌症研究所重症监护病房（ICU）中机械通气的ARDS患者RV功能障碍的发生率，并评估这些患者三尖瓣环平面收缩期位移（TAPSE）的系列变化。方法 这项前瞻性观察性研究纳入了40名年龄在18至80岁之间、因ARDS入住重症监护病房并接受机械通气的患者。符合入选标准的患者在入住ICU时进行常规检查。关键参数包括记录氧分压/吸入氧分数（PaO/FiO）氧合指数、二维经胸超声心动图上的TAPSE，以及在第0天、第2天和第5天进行血浆B型（或脑）利钠肽（BNP）水平测定。TAPSE值<17 mm被认为表明存在RV功能障碍。记录撤机结果、机械通气天数、ICU住院时间、住院时间和ICU内死亡率。结果 在40名研究参与者中，平均（±标准差）年龄为52.6（±14.3）岁，男性患者占52.5%。ARDS患者中RV功能障碍的发生率为17.5%。与基线相比，这些患者在第2天和第5天出现缺氧逐渐加重，同时血浆BNP水平显著升高。两组之间的撤机结果、机械通气天数、住院时间和ICU内死亡率相当。结论 本研究报告了ARDS患者中RV功能障碍的发生率为17.5%，并使用TAPSE量化了ARDS发病时RV功能的纵向恶化。纳入二维超声心动图上的客观指标，如TAPSE，便于在床边定期应用，并为临床医生提供了一种在ARDS早期检测和量化RV功能障碍的方法。
