Right atrial strain during prone ventilation in acute respiratory distress syndrome

Abstract

Although prone ventilation is widely used in acute respiratory distress syndrome (ARDS), its effects on right heart function, assessed by state-of-the-art echocardiography, are not well studied. We report the effect of prone ventilation on right atrial strain in severe ARDS after optimization of lung recruitment and hemodynamics using esophageal pressure and pulmonary artery catheter measurements, respectively. A 66-year-old obese man with ischemic heart failure was intubated due to ARDS. Before, during and after his first prone session, pulmonary, hemodynamic and echocardiographic (using twodimensional transthoracic speckle tracking echocardiography) parameters were measured. Prone ventilation sustainably improved lung recruitment and right atrial strain. Combining detailed physiological and advanced echocardiographic assessment provides insights into the effect of prone ventilation in ARDS.

Keywords

• acute respiratory failure
• mechanical ventilation
• esophageal pressure
• intensive care unit
• coronavirus
• hemodynamics