Continuous long‐term wireless measurement of right ventricular pressures and estimated diastolic pulmonary artery pressure in patients with severe COVID‐19 acute respiratory distress syndrome

Abstract

Aims We continuously monitored right ventricular pressures and the estimated diastolic pulmonary artery pressure (ePAD) for up to 30 days in mechanically ventilated patients with severe COVID‐19 acute respiratory distress syndrome in order to detect and treat right ventricular and pulmonary artery hypertension. Methods and Results We retrospectively evaluated right ventricular pressures and the ePAD measured in 30 invasively ventilated COVID‐19 acute respiratory distress syndrome patients between 1 October 2020 and 31 March 2021. We divided the patients into two groups, survivors and non‐survivors based on their 60 day mortality. Primary outcome variables were the values of right ventricular pressures and the ePAD over time after insertion of the right ventricular probe. Right ventricular systolic pressure [RVSP, (IQR; 25th to 75th percentile)] was significantly lower on the first and the last measurement day in the survivors compared with the non‐survivors [Day 1: 38 (27–45) vs. 46 (44–49), P = 0.036; last day: 36 (27–44) vs. 51 (40–57) mmHg, P = 0.006]. 16/22 survivors and 7/8 non‐survivors received sildenafil orally, one survivor received additionally inhaled nitric oxide and one survivor and one non‐survivor each inhaled iloprost. On the last measurement day, both right ventricular pressure amplitude [31 (26–37) vs. 38 (35–47) mmHg, P = 0.027] and ePAD [22 (16–26) vs. 31 (23–34) mmHg, P = 0.043] were significantly lower in the survivors compared with the non‐survivors. Four patients in the survivor group developed excessive high RVSP in the course of their disease (peak: 57/61/78/105 mmHg). After sildenafil 20 mg every 8 h, additional inhaled nitric oxide (20 ppm) in one and additional inhaled iloprost 20 μg every 4 h in another patient RVSP consecutively decreased substantially in all four patients until the end of the measurement period (47/23/42/47 mmHg). Conclusions The RVSP and right ventricular pressure amplitude both were significantly lower in the survivors compared with those in the non‐survivors with a significant decrease in RVSP over time in the survivors suggesting successful lowering by pulmonary vasodilators. The ePAD as an indicator of left heart failure was significantly higher in non‐survivors compared to the surviving patients.

Pressure‐based beat‐to‐beat right ventricular ejection fraction and Tau from continuous measured ventricular pressures in COVID‐19 ARDS patients

“…Thus, after adjustment of the offset, the probe correctly measured real‐time intracardial pressures with 30 days in vitro stability of 0.5 mmHg. 6 Transmission of continuous pressure recordings to the ICU bedside monitor and to a standard smartphone equipped with the CorLog application software (App) via an interface (CorLog Connect) as well as storage and transfer of all recorded data for off‐line analysis also have been described in detail previously. 6 …”

“…Independent outcome variables were the values of RVEF and the time constant Tau of the right ventricular diastolic isovolumetric relaxation time after insertion of the right ventricular probe as well as the right ventricular pressures and ePAD as described previously. 6 For the statistical analysis the day of insertion was set as Day 0. Values of variables were compared either at the start and end or over time of the measurement period between and within the two groups.…”

“…6 Transmission of continuous pressure recordings to the ICU bedside monitor and to a standard smartphone equipped with the CorLog application software (App) via an interface (CorLog Connect) as well as storage and transfer of all recorded data for off-line analysis also have been described in detail previously. 6 Identification of pressure points on the right ventricular pressure tracing Using the first and second derivate of the right ventricular pressure with regard to time we identified eight distinct pressures as described previously. 12,13 A typical recording incorporating all eight pressure points is shown in Figure 1.…”

Right Ventricular Injury Increases Mortality in Patients with Acute Respiratory Distress Syndrome on Veno-Venous Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

“…[20][21][22] One dataset was not included owing to a lack of consensus in the literature regarding a binary RVI cutoff. 23 One group did not respond, and the other was unable owing to a requirement to resubmit details to their Institutional Review Board. The latter two studies contained 49 potentially eligible patients…”

Monitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography

“…To monitor the right ventricular (RV) response, we used a CorLog Probe 1P (EMKA Medical GmbH, Aschaffenburg, Germany), which is a high-fidelity pressure measurement system designed for long-term use in the right ventricle. 1 The device is inserted through the subclavian vein and enables continuous pressure monitoring for ≤30 days with wireless data transfer to a smartphone application.…”