Cheong Issac, Álvarez Vilariño Federico Matías, Gómez Raúl Alejandro, Merlo Pablo Martín, Tamagnone Francisco Marcelo
Department of Critical Care Medicine, Sanatorio de Los Arcos, Buenos Aires, Argentina.
Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina.
J Clin Ultrasound. 2025 Jun;53(5):1004-1011. doi: 10.1002/jcu.23954. Epub 2025 Mar 18.
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).
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.
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 PaO/FiO 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).
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.
急性呼吸窘迫综合征（ARDS）常因后负荷增加和肺血管阻力升高导致右心室（RV）功能障碍。在ARDS管理的标准化治疗策略中，保护性通气以及在严重氧合恶化情况下采用俯卧位已被证明是有效的，俯卧位具有额外的益处，包括改善RV功能、增强诸如氧合和肺力学等生理指标。本研究旨在使用斑点追踪超声心动图（STE）评估俯卧位对ARDS患者RV功能的影响。
这项观察性、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RV功能的影响。该研究纳入了不同严重程度的ARDS且接受被动通气的患者。使用STE在仰卧位和俯卧位进行经胸超声心动图检查以评估RV功能，特别关注RV整体纵向应变（GLS）和RV游离壁应变（RVFWS）。
在2021年8月至2024年4月期间，共有16例接受机械通气的患者纳入该研究。关于机械通气参数，应用Bonferroni校正后，俯卧位期间的PaO/FiO比值有统计学显著升高（p = 0.004）。关于超声心动图变量，在左心室射血分数、RV基底直径、RV/左心室舒张末期面积比值或三尖瓣环组织S'波、TAPSE和RV面积变化分数的值方面未发现统计学显著差异。然而，在俯卧位期间，RV GLS（p = 0.009）和RVFWS（p = 0.003）有显著降低。
本研究为俯卧位操作对ARDS患者RV收缩功能的影响提供了初步见解，表明STE测量的应变可作为检测亚临床RV功能障碍的敏感标志物。需要更大样本量和前瞻性设计的进一步研究来证实并拓展这些发现。
