Characterization and Definition of Right Ventricular Injury in Patients Admitted to Intensive Care: Prospective Observational Study

Rationale Injury of the right ventricle (RV) is common in patients admitted to intensive care and impacts management and prognosis. Echocardiography has become the cornerstone of diagnosis and management of such an impairment. However, the many studies using echocardiography already published use different approaches to characterize and define "RV injury" making it difficult to accurately assess its incidence and prognostic impact. Briefly, 3 approaches are proposed. The first is based on a more cardiological approach that consists of using parameters of the RV systolic function, and defines the injury as these parameters estimates are below certain threshold. The most commonly used parameters are TAPSE, fractional area change, and Doppler velocity of the systolic (S') wave at the tricuspid annulus. The second approach is based on the pattern of cor pulmonale, defining RV injury as the presence of RV dilatation and paradoxical septal motion. The third approach is to define RV injury according to its consequences on upstream congestion (kidney, liver for example). This is probably the most physiological approach. It is thus defined as the association of an RV dilation with an abnormally high central venous pressure (CVP).

The hypothesis is that the best definition of RV injury is the one that will be best associated with hemodynamic status (e.g. the lack of response to volume expansion or its equivalent such as passive leg raising, PLR), ventilation and oxygenation parameters and with clinical outcomes, including mortality (ICU or in-hospital), duration of invasive ventilation (in ventilated patients), ICU length of stay and duration of catecholamine infusion.

All patients will receive a transthoracic (TTE) or a transesophageal (TEE) echocardiography according to the usual practice of the center and the patient's situation. A standard TTE or TEE echocardiography will be performed within 48 hours of inclusion (Echo-1), and another TTE or TEE (Echo-2) for fluid responsiveness study immediately after Echo-1.

The following information will be recorded

1. Patients characteristics (at admission and/or at inclusion) Date of ICU admission, date of inclusion, age, gender, past history of hypertension, diabetes mellitus, ischemic heart disease, cardiomyopathy of any cause, chronic kidney disease, COPD (chronic obstructive pulmonar disease), chronic PH (pulmonary hypertension), height, size (BMI), SAPS II, "primary" inclusion (within 2 days following admission) or "secondary" inclusion (during ICU stay), admission diagnosis: sepsis, septic shock, acute exacerbation of COPD, pulmonary embolism, acute asthma, drug poisoning, brain injury, myocardial infarction, pneumonia, COVID-19, miscellaneous.
2. Hemodynamic status (at the time of echo) Heart rate, sinus rhythm (Y/N), blood pressure (systolic, diastolic, mean), pulse pressure variations, PPV (if available), CVP (or RAP if PAC), serum lactate, base deficit, type of catecholamine and dose (in µg/kg/min), VA ECMO (yes/no).
3. Renal, liver function and biomarkers (at the time of echo or the closest to the study) Creatinine, ASAT, ALAT, bilirubin, platelets, troponin, BNP (if available)
4. Blood gas analysis (at the time of echo or the closest to the study) PaO2, PaO2/FiO2, PaCO2, pH, SaO2.
5. Ventilatory settings and oxygen delivery (at the time of echo)