Right Ventricular Dysfunction in Acute Respiratory Distress Syndrome and Its Quantification by Tricuspid Annular Plane Systolic Excursion on Transthoracic Echocardiography.

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.