ARDS Due to Disease Caused by SARS Co-V-2, Right Ventricular Dysfunction
Conditions
Keywords
transesophageal echocardiography, cards, heart lung interactions, prone position, right ventricle
Brief summary
In coronavirus disease-2019 (COVID-19)-related ARDS (C-ARDS), especially in the severe form, increased shunt rate, impaired ventilation/perfusion ratio (V/Q), hypoxic pulmonary vasoconstriction inhibition, and increased immune microthrombosis may have similar effects on the right ventricle .The cardiopulmonary pathophysiology and outcomes of C-ARDS vary, and this variability requires monitoring to follow the diagnosis and treatment process. This study aimed to increase the treatment success of the prone position in C-ARDS and to provide a prognostic factor for survival by analyzing and monitoring heart-lung interactions. Therefore, we used transesophageal echocardiography (TEE) to evaluate the cardiopulmonary effects of prone position.
Detailed description
This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with prone position in the first 48 hours of invasive mechanical ventilation support. It was evaluated with transesophageal echocardiography three times: before prone position (PP) (T0), the first hour of PP (T1), and the first hour of returning to the supine position (T0 + 24 hours) (T2) after 23 hours prone position treatment. Right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) was preferred right ventricular evaluations as primer outcome. Static compliance (C-stat) was examined in the evaluation of the pulmonary effect of prone position as secondary outcome.
Interventions
PROCEDUREbefore prone position
It was evaluated with transesophageal echocardiography
PROCEDUREthe first hour of prone position
It was evaluated with transesophageal echocardiography
PROCEDUREthe first hour of returning to the supine position
It was evaluated with transesophageal echocardiography
Sponsors
Bakirkoy Dr. Sadi Konuk Research and Training Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* \>18 years * Patients diagnosed with polymerase chain reaction/computed tomography results * Moderate/severe severity class according to the Berlin ARDS classification * Prone position applied in the first 48 h after orotracheal intubation in treatment * Obtaining an informed consent form
Exclusion criteria
* Pulmonary embolism * Pneumothorax * Heart valve disease * Pregnancy * Perforated esophageal varices * Coagulopathy * Esophageal stricture * Esophageal tumor * Neck fracture * Thrombocytopenia * Gastrointestinal bleeding * Previous stomach surgery * Previous esophageal surgery * Esophageal perforation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Right ventricular end-diastolic area/left ventricular end-diastolic area (RVEDA/LVEDA) change during prone position. | It was evaluated with transesophageal echocardiography three times: before prone position (T0), the first hour of prone position (T1), and the first hour of returning to the supine position (T0 + 24 hours) (T2) after 23 hours prone position treatment | It was preferred right ventricular recovery evaluation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Static compliance (C-stat) change with prone position | It was evaluated with transesophageal echocardiography three times: before prone position (T0), the first hour of prone position (T1), and the first hour of returning to the supine position (T0 + 24 hours) (T2) after 23 hours prone position treatment | It was examined in the evaluation of the pulmonary effect of prone position as secondary outcome. |
Countries
Turkey (Türkiye)
Outcome results
None listed