Right Ventricle Dilation Detected on Point-of-Care Ultrasound Is a Predictor of Poor Outcomes in Critically Ill Patients With COVID-19

Abstract

Background: During the COVID-19 pandemic, the need for judicious use of diagnostic tests and to limit personnel exposure has led to increased use and dependence on point-ofcare ultrasound (POCUS) examinations. We reviewed POCUS findings in patients admitted to the intensive care unit (ICU) for acute respiratory failure with COVID-19 and correlated the findings to severity of illness and 30-day outcomes. Methods: Patients admitted to the ICU in March and April 2020 were reviewed for inclusion (acute hypoxemic respiratory failure secondary to COVID-19 pneumonia; documentation of POCUS findings). Results: Forty-three patients met inclusion criteria. B lines and pleural thickening were associated with a lower PaO 2 / FiO 2 by 71 (P = .005; adjusted R 2 = 0.24). Right ventricle (RV) dilation was more common in patients with 30-day mortality (P = .02) and was a predictor of mortality when adjusted for hypertension, diabetes mellitus, and age (odds ratio,12.0; P = .048). All patients with RV dilation had bilateral B lines with pleural irregularities. Conclusions: Although lung ultrasound abnormalities are prevalent in patients with severe disease, RV involvement seems to be predictive of outcomes. Further studies are needed to discern the etiology and pathophysiology of RV dilation in COVID-19.

The Role of POCUS to Face COVID-19: A Narrative Review

“…There are similar retrospective studies that observed LUS's utility in monitoring patients with PaO2/FiO2 ratio <200 mmHg. Patients with a major LUS score value correlated with a worse outcome [42], or in a specular way, worse PaO2/FiO2 ratio correlated with worse LUS findings [43]. This kind of correlation was also observed for intubated patients [44].…”

Influence of right ventricular structure and function on hospital outcomes in COVID-19 patients

“…For the purposes of this discussion, we have selected and tabulated ( Table 5 ) prior relevant reports where there was sufficient data for between-study comparisons, including RV dysfunction, need for mechanical ventilation, and mortality rates. 2 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 To simplify the comparison between our study and the previously published reports, prior studies were sorted by the reported hospital mortality. Accounting for differences in study populations and reported endpoints, our findings agree with prior reports.…”

“… In the studies with available data endpoints, including current one (star), visual assessment reveals strong positive correlation between RV dilatation and mortality (Panel A), RV dilatation and positive pressure ventilation (Panel B), and positive pressure ventilation and mortality (Panel C). 2 , 11 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 …”

A role for Toll-like receptor 3 in lung vascular remodeling associated with SARS-CoV-2 infection

“…Early in the COVID-19 pandemic data appeared indicating right ventricular strain and remodeling, as well as heterogenous pulmonary perfusion and pulmonary vascular remodeling, in patients with COVID-19 9,38,39 . Furthermore, reports showed the emergence of PH in patients who had no prior history of lung vascular disease 7,9 .…”