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Right Ventricle Dilation Detected on Point-of-Care Ultrasound Is a Predictor of Poor Outcomes in Critically Ill
Pooja Belligund1, David Lee1, Mehrala Balasubramaniam1
1, , and are all staff physicians in the Division of Pulmonary and Critical Medicine; is the Director of the Intensive Care Unit in the Division of Pulmonary and Critical Care Medicine, and is Chief of the Division of Pulmonary and Critical Care Medicine. is a Staff Physician in the Division of Cardiology; all at US Department of Veterans Affairs New York Harbor Healthcare System in Brooklyn, New York. All are Assistant Professors of Medicine at SUNY Downstate Health Sciences University in Brooklyn. , and are current or former Fellows in the Division of Pulmonary and Critical Care Medicine; and are Residents in the Department of Internal Medicine; is a Fellow in the Division of Cardiology; all at SUNY Downstate Health Sciences University in Brooklyn. is a Nephrology and Critical Care Staff Physician at the VA Puget Sound Health Care System in Seattle, Washington. is a Staff Physician and Associate Professor Medicine at the Cleveland Clinic, Respiratory Institute in Beachwood, Ohio.
Background:
During the COVID-19 pandemic, the need for judicious use of diagnostic tests and to limit personnel exposure has led to increased use and dependence on point-of-care ultrasound (POCUS) examinations. We reviewed POCUS findings in patients admitted to the intensive care unit (ICU) for acute respiratory failure with COVID-19 and correlated the findings to severity of illness and 30-day outcomes.
Methods:
Patients admitted to the ICU in March and April 2020 were reviewed for inclusion (acute hypoxemic respiratory failure secondary to COVID-19 pneumonia; documentation of POCUS findings).
Results:
Forty-three patients met inclusion criteria. B lines and pleural thickening were associated with a lower PaO2/FiO2 by 71 (P = .005; adjusted R 2 = 0.24). Right ventricle (RV) dilation was more common in patients with 30-day mortality (P = .02) and was a predictor of mortality when adjusted for hypertension, diabetes mellitus, and age (odds ratio, 12.0; P = .048). All patients with RV dilation had bilateral B lines with pleural irregularities.
Conclusions:
Although lung ultrasound abnormalities are prevalent in patients with severe disease, RV involvement seems to be predictive of outcomes. Further studies are needed to discern the etiology and pathophysiology of RV dilation in COVID-19.
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