An Evidence-Based Echocardiographic Image Acquisition Protocol for Evaluating Right Ventricular Function

A major risk factor for morbidity and mortality in critical illness is the presence of right ventricular dysfunction (RVD). However, characterizing and grading the severity of RVD remains highly subjective, with significant inter-operator and intra-operator variability and the potential for the inappropriate treatment of patients. To address these issues, this study aimed to synthesize multiple echocardiographic parameters, which have been demonstrated to affect clinical outcomes, into a framework for the comprehensive evaluation of RVD. During the study's first phase, a scoping review of the literature was conducted and identified four routinely obtained echocardiographic findings that had been validated as part of multi-parametric scoring methods for scoring the severity RVD: (1) RV systolic dysfunction; (2) RV dilation; (3) RV-PA uncoupling; and (4) interventricular septal flattening. In the second phase described in the present manuscript, these four echocardiographic findings were operationalized into an image acquisition protocol and integrated into a proposed RVD scoring system compatible with the constraints of either point-of-care or consultative ultrasound workflows.