Right Heart Function in Critically Ill Patients at Risk for Acute Right Heart Failure: A Description of Right Ventricular-Pulmonary Arterial Coupling, Ejection Fraction and Pulmonary Artery Pulsatility Index
| Autor: | Mary C. McCarthy, Kathryn M. Tchorz, Muddassir Mehmood, Robert W Biederman, Ronald J. Markert |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Resuscitation Cardiac Catheterization medicine.medical_treatment Critical Illness Heart Ventricles Hemodynamics 030204 cardiovascular system & hematology Pulmonary Artery 03 medical and health sciences 0302 clinical medicine Internal medicine medicine.artery medicine Humans 030212 general & internal medicine Prospective Studies Heart Failure Ejection fraction business.industry Gold standard Pulmonary artery catheter Stroke Volume Middle Aged Catheter medicine.anatomical_structure Pulmonary artery Acute Disease Cardiology Vascular resistance Ventricular Function Right Female Vascular Resistance Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Heart, lungcirculation. 29(6) |
| ISSN: | 1444-2892 |
| Popis: | Background The gold standard for right heart function is the assessment of right ventricular-pulmonary arterial coupling defined as the ratio of arterial to end-systolic elastance (Ea/Emax). This study demonstrates the use of the volumetric pulmonary artery (PA) catheter for estimation of Ea/Emax and describes trends of Ea/Emax, right ventricular ejection fraction (RVEF), and pulmonary artery pulsatility index (PAPi) during initial 48 hours of resuscitation in the trauma surgical intensive care unit (ICU). Methods Review of prospectively collected data for 32 mechanically ventilated adult trauma and emergency general surgery patients enrolled within 6 hours of admission to the ICU. Haemodynamics, recorded every 12 hours for 48 hours, were compared among survivors and non-survivors to hospital discharge. Results Mean age was 49 ± 20 years, 69% were male, and 84% were trauma patients. Estimated Ea/Emax was associated with pulmonary vascular resistance and inversely related to pulmonary arterial capacitance and PA catheter derived RVEF. Seven (7) trauma patients did not survive to hospital discharge. Non-survivors had higher estimated Ea/Emax, suggesting right ventricular-pulmonary arterial uncoupling, with a statistically significant difference at 48 hours (2.3 ± 1.7 vs 1.0 ± 0.58, p = 0.018). RVEF was significantly lower in non-survivors at study initiation and at 48 hours. PAPi did not show a consistent trend. Conclusions Estimation of Ea/Emax using volumetric PA catheter is feasible. Serial assessment of RVEF and Ea/Emax may help in early identification of right heart dysfunction in critically ill mechanically ventilated patients at risk for acute right heart failure. |
| Databáze: | OpenAIRE |
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