Optimal right heart filling pressure in acute respiratory distress syndrome determined by strain echocardiography

被引:10
作者
Garcia-Montilla, Romel [1 ,2 ]
Imam, Faryal [2 ]
Miao, Mi [2 ]
Stinson, Kathryn [2 ]
Khan, Akram [2 ]
Heitner, Stephen [3 ]
机构
[1] Marshfield Clin Fdn Med Res & Educ, Dept Trauma Surg & Surg Crit Care, Marshfield, WI 54449 USA
[2] Oregon Hlth & Sci Univ, Div Pulm & Crit Care Med, Portland, OR 97201 USA
[3] Oregon Hlth & Sci Univ, Knight Cardiovasc Inst, Clin Echocardiog, Portland, OR 97201 USA
来源
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES | 2017年 / 34卷 / 06期
关键词
acute respiratory distress syndrome; filling pressure; right ventricle; strain echocardiography; RIGHT-VENTRICULAR FUNCTION; SPECKLE TRACKING ECHOCARDIOGRAPHY; CARDIAC MAGNETIC-RESONANCE; INTENSIVE-CARE-UNIT; STROKE WORK INDEX; PREDICT FLUID RESPONSIVENESS; CRITICALLY-ILL PATIENTS; CENTRAL VENOUS-PRESSURE; LONGITUDINAL STRAIN; PULMONARY-HYPERTENSION;
D O I
10.1111/echo.13546
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
IntroductionRight ventricular (RV) systolic dysfunction is common in acute respiratory distress syndrome (ARDS). While preload optimization is crucial in its management, dynamic fluid responsiveness indices lack reliability, and there is no consensus on target central venous pressure (CVP). We analyzed the utility of RV free wall longitudinal strain (RVFWS) in the estimation of optimal RV filling pressure in ARDS. MethodsA retrospective cross-sectional analysis of clinical data and echocardiograms of patients with ARDS was performed. Tricuspid annular plane systolic excursion (TAPSE), tricuspid peak systolic velocity (S'), RV fractional area change (RVFAC), RVFWS, CVP, systolic pulmonary artery pressure (SPAP), and left ventricular ejection fraction (LVEF) were measured. ResultsFifty-one patients with moderate-severe ARDS were included. There were inverse correlations between CVP and TAPSE, S', RVFAC, RVFWS, and LVEF. The most significant was with RVFWS (r:.74, R-2:.55, P:.00001). Direct correlations with creatinine and lactate were noted. Receiver operating characteristic analysis showed that RVFWS -21% (normal reference value) was associated with CVP: 13mm Hg (AUC: 0.92, 95% CI: 0.83-1.00). Regression model analysis of CVP, and RVFWS interactions established an RVFWS range from -18% to -24%. RVFWS -24% corresponded to CVP: 11mm Hg and RVFWS -18% to CVP: 15mm Hg. Beyond a CVP of 15mm Hg, biventricular systolic dysfunction rapidly ensues. ConclusionsOur data are the first to show that an RV filling pressure of 13 +/- 2mm Hgas by CVPcorrelates with optimal RV mechanics as evaluated by strain echocardiography in patients with moderate-severe ARDS.
引用
收藏
页码:851 / 861
页数:11
相关论文
共 71 条
[1]   Assessment of Right Ventricular Function Using Echocardiographic Speckle Tracking of the Tricuspid Annular Motion: Comparison with Cardiac Magnetic Resonance [J].
Ahmad, Homaa ;
Mor-Avi, Victor ;
Lang, Roberto M. ;
Nesser, Hans-Joachim ;
Weinert, Lynn ;
Tsang, Wendy ;
Steringer-Mascherbauer, Regina ;
Niel, Johannes ;
Salgo, Ivan S. ;
Sugeng, Lissa .
ECHOCARDIOGRAPHY-A JOURNAL OF CARDIOVASCULAR ULTRASOUND AND ALLIED TECHNIQUES, 2012, 29 (01) :19-24
[2]  
[Anonymous], 2012, CARDIOVASCULAR PHYSL
[3]   Noninvasive Evaluation of Right Atrial Pressure [J].
Beigel, Roy ;
Cercek, Bojan ;
Luo, Huai ;
Siegel, Robert J. .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2013, 26 (09) :1033-1042
[4]  
BERISHA S, 1990, BRIT HEART J, V63, P98
[5]   Understanding venous return [J].
Berlin, David A. ;
Bakker, Jan .
INTENSIVE CARE MEDICINE, 2014, 40 (10) :1564-1566
[6]   Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome [J].
Boissier, Florence ;
Katsahian, Sandrine ;
Razazi, Keyvan ;
Thille, Arnaud W. ;
Roche-Campo, Ferran ;
Leon, Rusel ;
Vivier, Emmanuel ;
Brochard, Laurent ;
Vieillard-Baron, Antoine ;
Brun-Buisson, Christian ;
Dessap, Armand Mekontso .
INTENSIVE CARE MEDICINE, 2013, 39 (10) :1725-1733
[7]   Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. [J].
Brower, RG ;
Matthay, MA ;
Morris, A ;
Schoenfeld, D ;
Thompson, BT ;
Wheeler, A ;
Wiedemann, HP ;
Arroliga, AC ;
Fisher, CJ ;
Komara, JJ ;
Perez-Trepichio, P ;
Parsons, PE ;
Wolkin, R ;
Welsh, C ;
Fulkerson, WJ ;
MacIntyre, N ;
Mallatratt, L ;
Sebastian, M ;
McConnell, R ;
Wilcox, C ;
Govert, J ;
Thompson, D ;
Clemmer, T ;
Davis, R ;
Orme, J ;
Weaver, L ;
Grissom, C ;
Eskelson, M ;
Young, M ;
Gooder, V ;
McBride, K ;
Lawton, C ;
d'Hulst, J ;
Peerless, JR ;
Smith, C ;
Brownlee, J ;
Pluss, W ;
Kallet, R ;
Luce, JM ;
Gottlieb, J ;
Elmer, M ;
Girod, A ;
Park, P ;
Daniel, B ;
Gropper, M ;
Abraham, E ;
Piedalue, F ;
Glodowski, J ;
Lockrem, J ;
McIntyre, R .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (18) :1301-1308
[8]   Right Ventricular Longitudinal Strain and Right Ventricular Stroke Work Index in Patients With Severe Heart Failure: Left Ventricular Assist Device Suitability for Transplant Candidates [J].
Cameli, M. ;
Bernazzali, S. ;
Lisi, M. ;
Tsioulpas, C. ;
Croccia, M. G. ;
Lisi, G. ;
Maccherini, M. ;
Mondillo, S. .
TRANSPLANTATION PROCEEDINGS, 2012, 44 (07) :2013-2015
[9]   Right Ventricular Longitudinal Strain Correlates Well With Right Ventricular Stroke Work Index in Patients With Advanced Heart Failure Referred for Heart Transplantation [J].
Cameli, Matteo ;
Lisi, Matteo ;
Righini, Francesca Maria ;
Tsioulpas, Charilaos ;
Bernazzali, Sonia ;
Maccherini, Massimo ;
Sani, Guido ;
Ballo, Piercarlo ;
Galderisi, Maurizio ;
Mondillo, Sergio .
JOURNAL OF CARDIAC FAILURE, 2012, 18 (03) :208-215
[10]   Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking [J].
Cameli, Matteo ;
Caputo, Maria ;
Mondillo, Sergio ;
Ballo, Piercarlo ;
Palmerini, Elisabetta ;
Lisi, Matteo ;
Marino, Enzo ;
Galderisi, Maurizio .
CARDIOVASCULAR ULTRASOUND, 2009, 7