ECHOCARDIOGRAPHIC EVALUATION OF RIGHT VENTRICLE FUNCTION IN MECHANICALLY
VENTILATED CHILDREN
Abstract
Objectives: Right ventricle (RV) dysfunction has a significant impact on
the morbidity and mortality of critically ill patients and is associated
with worse outcomes. This study aims to analyze the frequency of
echocardiographic alterations of the RV in children undergoing invasive
mechanical ventilation (IMV). Methods: Observational study conducted on
patients undergoing mechanical ventilation in a pediatric intensive care
unit from May 2019 to June 2022. Bedside echocardiograms were performed,
and measurements of tricuspid annular plane systolic excursion (TAPSE),
tissue Doppler S’ wave, and right ventricle/left ventricle (RV/LV) ratio
were evaluated. Results: A total of 146 echocardiograms were analyzed,
with a median age of 7 months, 64.4% were infants, and 51.4% were
female. It was observed that 24% (35) had TAPSE alterations, 14% (20)
had alterations in the S’ wave, and 10.7% (15) had RV/LV ratio altered.
Considering RV dysfunction as any of these altered parameters, the
frequency was 38.5% (55), with cardiac index weakly correlated with
TAPSE (r=0.171; p<0.048) and S’ wave (r=0.281;
p<0.001). There was no significant association between
echocardiographic alterations and respiratory parameters. Regarding
hemodynamic status, the median Vasoactive-inotropic Score was higher in
the dysfunction group (7.5 vs. 3; p<0.048), as well as lactate
levels (1.74 vs. 1.3; p<0.015). None of the variables were
associated with mortality, duration of IMV or length of hospital stay.
Conclusions: Echocardiographic alterations of the RV are frequent in
children undergoing MV. Echocardiography is a non-invasive tool that
aids in identifying this condition, which can impact the management of
critically ill patients.