Descripción ecocardiográfica de la función del ventrículo derecho en los pacientes críticamente enfermos. Revisión de una cohorte

Abstract

Introduction

Right ventricular ultrasonography is indicated in patients with chest pain, dyspnea, hypotension, tachycardia, hypoxemia, shock, or respiratory failure. An increasing number of acute and chronic conditions have been associated with RV diastolic dysfunction, including pressure and volume overload pathologies, primary lung disease, ischemic heart disease, congenital heart disease, cardiomyopathies, left ventricular dysfunction (when ventricular interdependence exists), systemic diseases, and the physiological aging process. Other critical situations such as shock, cardiac arrest, mechanical ventilation, and CO2 are also associated with this dysfunction. Echocardiographic variables such as tricuspid annular plane systolic excursion (TAPSE), pulsed Doppler S wave (S′), and fractional area change (FAC) are indicators of RV systolic dysfunction.

Material and methodology

A 6-month observational, descriptive, longitudinal, and prospective study was conducted in the Intensive Care Unit (ICU) of a tertiary care hospital in Mexico City. The RV function of 100 patients was evaluated via echocardiography at ICU admission and 24 hours later, analyzing variables such as TAPSE, S′, FAC, pulmonary artery systolic pressure (PASP), pulmonary mesosystolic notch, and tricuspid regurgitation (TR).

Results

The main admission diagnoses were septic shock (24%), pneumonia and acute respiratory distress syndrome (ARDS) (21%), hypovolemic shock (14%), and congestive heart failure (CHF) (8%). A total of 77% of patients required invasive mechanical ventilation, with 29% presenting RV failure at admission and 28% after 24 hours. Significant associations were found between RV failure and PASP > 40 mmHg, mesosystolic notch, ARDS secondary to community-acquired pneumonia (CAP), CHF, septic shock, hypovolemic shock, PaCO2, and PaO2/FiO2.

Conclusion

One-third of ICU patients exhibit signs of RV failure, and a similar proportion continue to show this diagnosis 24 hours later. ARDS secondary to CAP, CHF, septic shock, hypovolemic shock, PASP > 40 mmHg, mesosystolic notch, PaCO2 > 48 mmHg, and PaO2/FiO2 < 150 mmHg are associated with RV failure. Echocardiographic evaluation from ICU admission is crucial for detecting and preventing severe complications.