Abnormal Right Ventricular Myocardial Performance Index Is Not Associated With Outcomes in Invasively Ventilated Intensive Care Unit Patients Without Acute Respiratory Distress Syndrome- Post hoc Analysis of Two RCTs

Charalampos Pierrakos; Anna Geke Algera; Fabienne Simonis; Thomas G V Cherpanath; Wim K Lagrand; Frederique Paulus; Lieuwe D J Bos; Marcus J Schultz; PReVENT– and RELAx–Investigators

doi:10.3389/fcvm.2022.830165

Abnormal Right Ventricular Myocardial Performance Index Is Not Associated With Outcomes in Invasively Ventilated Intensive Care Unit Patients Without Acute Respiratory Distress Syndrome- Post hoc Analysis of Two RCTs

Front Cardiovasc Med. 2022 May 31:9:830165. doi: 10.3389/fcvm.2022.830165. eCollection 2022.

Affiliations

¹ Laboratory of Experimental Intensive Care and Anesthesiology (L⋅E⋅I⋅C⋅A), Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, Netherlands.
² Department of Intensive Care, Brugmann University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
³ Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.
⁴ Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.

Abstract

Background: The objective of the study was to determine the association between right ventricular (RV) myocardial performance index (MPI) and successful liberation from the ventilator and death within 28 days.

Methods: Post hoc analysis of 2 ventilation studies in invasively ventilated patients not having ARDS. RV-MPI was collected through transthoracic echocardiography within 24-48 h from the start of invasive ventilation according to the study protocols. RV-MPI ≤ 0.54 was considered normal. The primary endpoint was successful liberation from the ventilator < 28 days; the secondary endpoint was 28-day mortality.

Results: A total of 81 patients underwent transthoracic echocardiography at median 30 (24-42) h after the start of ventilation-in 73 (90%) patients, the RV-MPI could be collected. A total of 56 (77%) patients were successfully liberated from the ventilator < 28 days; A total of 22 (30%) patients had died before or at day 28. A total of 18 (25%) patients had an abnormal RV-MPI. RV-MPI was neither associated with successful liberation from the ventilator within 28 days [HR, 2.2 (95% CI 0.47-10.6); p = 0.31] nor with 28-day mortality [HR, 1.56 (95% CI 0.07-34.27); p = 0.7].

Conclusion: In invasively ventilated critically ill patients without ARDS, an abnormal RV-MPI indicative of RV dysfunction was not associated with time to liberation from invasive ventilation.

Keywords: echocardiography; heart-lung interactions; hemodynamic monitoring; mechanical ventilation; mortality; successful extubation.