Clinical presentation and management of right ventricular dysfunction

Murphy, Emma; Shelley, Benjamin

doi:10.1016/j.bjae.2019.02.004

Cited by 13 publications

(17 citation statements)

References 18 publications

(23 reference statements)

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“…Although we have identified important associations between possible causative mechanisms and abnormal RVFWLS, it is important to highlight that in general patient characteristics were similar between normal RVFWLS and abnormal RVFWLS groups. RVD is increasingly recognised as manifesting in a covert manner [37]. We have found that RVD can be subtle and difficult to diagnose clinically; however, it has a significant impact on survival.…”

Section: Discussionmentioning

confidence: 97%

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

McErlane

McCall

Willder

et al. 2022

Ann. Intensive Care

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Background Right ventricular (RV) dysfunction has been commonly reported in patients with Coronavirus disease 2019 (COVID-19), and is associated with mortality in mixed cohorts of patients requiring and not requiring invasive mechanical ventilation (IMV). Using RV-speckle tracking echocardiography (STE) strain analysis, we aimed to identify the prevalence of RV dysfunction (diagnosed by abnormal RV-STE) in patients with COVID-19 that are exclusively undergoing IMV, and assess association between RV dysfunction and 30 day mortality. We performed a prospective multicentre study across 10 ICUs in Scotland from 2/9/20 to 22/3/21. One-hundred-and-four echocardiography scans were obtained from adult patients at a single timepoint between 48 h after intubation, and day 14 of intensive care unit admission. We analysed RV-STE using RV free-wall longitudinal strain (RVFWLS), with an abnormal cutoff of > −20%. We performed survival analysis using Kaplan–Meier, log rank, and multivariate cox-regression (prespecified covariates were age, gender, ethnicity, severity of illness, and time since intubation). Results Ninety-four/one-hundred-and-four (90.4%) scans had images adequate for RVFWLS. Mean RVFWLS was −23.0% (5.2), 27/94 (28.7%) of patients had abnormal RVFWLS. Univariate analysis with Kaplan–Meier plot and log-rank demonstrated that patients with abnormal RVFWLS have a significant association with 30-day mortality (p = 0.047). Multivariate cox-regression demonstrated that abnormal RVFWLS is independently associated with 30-day mortality (Hazard-Ratio 2.22 [1.14–4.39], p = 0.020). Conclusions Abnormal RVFWLS (> −20%) is independently associated with 30-day mortality in patients with COVID-19 undergoing IMV. Strategies to prevent RV dysfunction, and treatment when identified by RVFWLS, may be of therapeutic benefit to these patients. Trial Registration: Retrospectively registered 21st Feb 2021. ClinicalTrials.gov Identifier: NCT04764032.

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Section: Discussionmentioning

confidence: 97%

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

McErlane

McCall

Willder

et al. 2022

Ann. Intensive Care

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“…The results of our study would prompt a serious and organized approach prior to intubation of critically ill patients with pre-existing RV dysfunction. 37 The findings support potential interventions and therapies targeting RV function and hemodynamic parameters' optimization before intubation. This may include pre-intubation hemodynamic support with vasoactive and inotropic medications, 38,39 judicious intravenous fluid bolus, 18,40 cautious use of inductive sedative medications, pre and apneic oxygenation, 1,25,41 awake intubation versus modified rapid sequence or delayed sequence intubation 25,26,42,43 and implementing intubation check list and a bundle protocol for management of complications related to endotracheal intubation in such high risk patients.…”

Section: Discussionmentioning

confidence: 56%

Pre-Existing Right Ventricular Dysfunction as an Independent Risk Factor for Post Intubation Cardiac Arrest and Hemodynamic Instability in Critically Ill Patients: A Retrospective Observational Study

Al-Saadi

Heidari

Donahue

et al. 2022

J Intensive Care Med

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Background Post intubation cardiac arrest and hemodynamic instability are serious adverse events encountered in critically ill patients. The association of pre-existing right ventricular (RV) dysfunction with post intubation cardiac arrest and hemodynamic instability in critically ill patients is unknown. Methods This is a retrospective matched cohort study of adult critically ill patients who underwent intubation from July 2016 to December 2019. The study was conducted at a quaternary medical center in Houston, Texas. A total of 340 critically ill patients who underwent intubation in the intensive care units, wards, and the emergency room were included. The study cohort was categorized into 4 groups based on the pre-existing RV function: normal function, mild dysfunction, moderate dysfunction, and severe dysfunction. Cardiac arrest and/or hemodynamic instability within one hour post intubation were the primary study outcomes. Secondary outcomes included in hospital and 60-day mortality. Results Study patients were of mean age of 61.95 ± 14.28 years, including 132 (39%) females and 208 (61%) males. The primary outcomes were significantly worse in mild, moderate, and severe RV dysfunction groups compared to the normal RV function group (34.12%-P = 0.014, 47.06%-P < 0.001, 51.67%-P < 0.001, vs. 17.56%). In a multivariable logistic regression analysis, pre-existing moderate (OR = 2.65, P = 0.013) and severe RV dysfunction groups (OR = 2.66, P = 0.015) were associated with statistically significant higher cardiac arrest and hemodynamic instability post intubation. Pre-existing severe RV dysfunction was associated with statistically significant higher in hospital mortality (62.35%-P < 0.001). The multivariable Cox-regression analysis showed that pre-existing severe RV dysfunction was associated with a statistically significant higher 60-day mortality (HR = 2.57, P = 0.001). Conclusions Pre-existing moderate and severe RV dysfunctions were independently associated with significantly higher cardiac arrest and/or hemodynamic instability post intubation in critically ill patients. Pre-existing RV function may serve as a mortality predictor in critically ill patients undergoing endotracheal intubation.

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“…Because of this, we have decided to employ the NO in this instance. Nitric oxide improves V/Q mismatch, oxygenation, RV systolic function, and mixed venous oxygen saturation by reducing PVR only in parts of the lung that are well ventilated [9].…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Right Pneumonectomy with a Focus on the Right Ventricular Function and Hemodynamic Management

Logato¹,

Faria²,

Freitas³

et al. 2022

OJAnes

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Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.

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Clinical presentation and management of right ventricular dysfunction

Abstract: Mesh keywords: right ventricle, Right ventricular dysfunction, critical care.

Cited by 13 publications

References 18 publications

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

Right ventricular free wall longitudinal strain is independently associated with mortality in mechanically ventilated patients with COVID-19

Pre-Existing Right Ventricular Dysfunction as an Independent Risk Factor for Post Intubation Cardiac Arrest and Hemodynamic Instability in Critically Ill Patients: A Retrospective Observational Study

A Case Report of Right Pneumonectomy with a Focus on the Right Ventricular Function and Hemodynamic Management

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