RIGHT VENTRICULAR PERFORMANCE IN MECHANICALLY VENTILATED POLYTRAUMATIZED PATIENTS BASED ON ASSESSMENT OF TRICUSPID ANNULAR PLANE SYSTOLIC EXCURSION AND RIGHT VENTRICULAR FRACTIONAL AREA CHANGE

Abstract

Even in terms of using lung protective strategies, mechanical ventilation could lead to different types of lung injury with severe consequences over systemic and pulmonary hemodynamics, showing deleterious properties over the right ventricular performance as well. Fifty polytraumatized patients admitted in the ICU were included in this prospective study. They were divided into two groups regarding the need for mechanical ventilation. In all patients we have examined Right heart function by measuring Tricuspid Annular Plane Systolic Excursion (TAPSE) and Fractional Area Change (FAC) 24 hours, 7 and 14 days after admission in the ICU. Statistical analysis was done with calculating the mean value of TAPSE and FAC, as well as with using Mann Whitney U Test. In both groups, mechanically ventilated and spontaneously breathing patients, values for TAPSE were not significantly different at all examination points. The values for FAC were significantly lower in the group of mechanically ventilated patients after 7 and 14 days of mechanical ventilation initiation (U=275; 163,5; 86,5 and z= 0,7; 2,02; 1,96 for p value of 0,47; 0,04 and 0,04 respectively). TAPSE as a surrogate for the assessment of longitudinal systolic function of the right ventricle, has been intact in both groups regardless the usage of mechanical ventilation, but radial systolic function of the right ventricle was significantly lower 7 and 14 days after starting mechanical ventilation. Impairment of the radial systolic function of the right ventricle with preserved longitudinal systolic function was previously reported in patients with high pulmonary pressures and elevated right ventricular afterload.  The mechanical ventilation is associated with radial right ventricular systolic dysfunction and with lower values for FAC in mechanically ventilated compared to spontaneously breathing polytraumatized patients.