Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic

INTRODUCTION

Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients.

METHODS

Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded.

RESULTS

A total of 77 patients with a mean age of 62 ± 13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc.

CONCLUSIONS

In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.

Invasive pulmonary aspergillosis in the COVID-19 era: An expected new entity

OBJECTIVES

Information on the recently COVID-19-associated pulmonary aspergillosis (CAPA) entity is scarce. We describe eight CAPA patients, compare them to colonised ICU patients with coronavirus disease 2019 (COVID-19), and review the published literature from Western countries.

METHODS

Prospective study (March to May, 2020) that included all COVID-19 patients admitted to a tertiary hospital. Modified AspICU and European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria were used.

RESULTS

COVID-19-associated pulmonary aspergillosis was diagnosed in eight patients (3.3% of 239 ICU patients), mostly affected non-immunocompromised patients (75%) with severe acute respiratory distress syndrome (ARDS) receiving corticosteroids. Diagnosis was established after a median of 15 days under mechanical ventilation. Bronchoalveolar lavage was performed in two patients with positive Aspergillus fumigatus cultures and galactomannan (GM) index. Serum GM was positive in 4/8 (50%). Thoracic CT scan findings fulfilled EORTC/MSG criteria in one case. Isavuconazole was used in 4/8 cases. CAPA-related mortality was 100% (8/8). Compared with colonised patients, CAPA subjects were administered tocilizumab more often (100% vs. 40%, p = .04), underwent longer courses of antibacterial therapy (13 vs. 5 days, p = .008), and had a higher all-cause mortality (100% vs. 40%, p = .04). We reviewed 96 similar cases from recent publications: 59 probable CAPA (also putative according modified AspICU), 56 putative cases and 13 colonisations according AspICU algorithm; according EORTC/MSG six proven and two probable. Overall, mortality in the reviewed series was 56.3%.

CONCLUSIONS

COVID-19-associated pulmonary aspergillosis must be considered a serious and potentially life-threatening complication in patients with severe COVID-19 receiving immunosuppressive treatment.

Adipose-derived mesenchymal stromal cells for the treatment of patients with severe SARS-CoV-2 pneumonia requiring mechanical ventilation. A proof of concept study

BACKGROUND

Identification of effective treatments in severe cases of COVID-19 requiring mechanical ventilation represents an unmet medical need. Our aim was to determine whether the administration of adipose-tissue derived mesenchymal stromal cells (AT-MSC) is safe and potentially useful in these patients.

METHODS

Thirteen COVID-19 adult patients under invasive mechanical ventilation who had received previous antiviral and/or anti-inflammatory treatments (including steroids, lopinavir/ritonavir, hydroxychloroquine and/or tocilizumab, among others) were treated with allogeneic AT-MSC. Ten patients received two doses, with the second dose administered a median of 3 days (interquartile range-IQR- 1 day) after the first one. Two patients received a single dose and another patient received 3 doses. Median number of cells per dose was 0.98 × 10⁶ (IQR 0.50 × 10⁶) AT-MSC/kg of recipient's body weight. Potential adverse effects related to cell infusion and clinical outcome were assessed. Additional parameters analyzed included changes in imaging, analytical and inflammatory parameters.

FINDINGS

First dose of AT-MSC was administered at a median of 7 days (IQR 12 days) after mechanical ventilation. No adverse events were related to cell therapy. With a median follow-up of 16 days (IQR 9 days) after the first dose, clinical improvement was observed in nine patients (70%). Seven patients were extubated and discharged from ICU while four patients remained intubated (two with an improvement in their ventilatory and radiological parameters and two in stable condition). Two patients died (one due to massive gastrointestinal bleeding unrelated to MSC therapy). Treatment with AT-MSC was followed by a decrease in inflammatory parameters (reduction in C-reactive protein, IL-6, ferritin, LDH and d-dimer) as well as an increase in lymphocytes, particularly in those patients with clinical improvement.

INTERPRETATION

Treatment with intravenous administration of AT-MSC in 13 severe COVID-19 pneumonia under mechanical ventilation in a small case series did not induce significant adverse events and was followed by clinical and biological improvement in most subjects.

FUNDING

None.

Clinical characteristics, evolution, and treatment-related risk factors for mortality among immunosuppressed patients with influenza A (H1N1) virus admitted to the intensive care unit

PURPOSE

Information about immunocompromised patients infected with influenza A (H1N1) virus and requiring admission to the ICU is lacking. Our objective was to know the clinical characteristics of these patients and to identify treatment-related variables associated with mortality.

MATERIAL AND METHODS

A prospective multicenter observational cohort study was based on data from a Spanish registry (2009-2015) collected by 148 Spanish ICUs. All patients admitted to the ICU with the diagnosis of influenza A (H1N1) virus infection were included. Immunosuppression was clearly defined. Factors associated with mortality in immunocompromised patients were assessed by conventional logistic regression analysis and by a propensity score (PS) adjusted-multivariable analysis.

RESULTS

Of 1899 patients with influenza A (H1N1) infection, 238 (12.5%) were classified as immunocompromised. Mortality was significantly higher in immunosuppressed patients. Four variables independently associated with mortality were identified: SOFA score, need of vasopressor, use of corticosteroids, and acute renal failure, AKIN 3 stage. In the PS-adjusted model, corticosteroid therapy remained as an independent factor associated with increased mortality (OR 2.25;95%CI, 1.15-4.38;p = 0.017). In the subgroup of hematological patients (n = 141), corticosteroid therapy was also associated with increased mortality (OR 3.12; 95%CI, 1.32-7.41; p = 0.010).

CONCLUSION

Immunocompromised individuals with influenza A (H1N1) admitted to the ICU have a poor outcome. In this population, the use of corticosteroids is strongly discouraged.

Design and verification of the shielding around the new Neutron Standards Laboratory (LPN) at CIEMAT

The construction of the new Neutron Standards Laboratory at CIEMAT (Laboratorio de Patrones Neutrónicos) has been finalised and is ready to provide service. The facility is an ∼8 m×8 m×8 m irradiation vault, following the International Organization for Standardization 8529 recommendations. It relies on several neutron sources: a 5-GBq (5.8× 10(8) s(-1)) (252)Cf source and two (241)Am-Be neutron sources (185 and 11.1 GBq). The irradiation point is located 4 m over the ground level and in the geometrical centre of the room. Each neutron source can be moved remotely from its storage position inside a water pool to the irradiation point. Prior to this, an important task to design the neutron shielding and to choose the most appropriate materials has been developed by the Radiological Security Unit and the Ionizing Radiations Metrology Laboratory. MCNPX was chosen to simulate the irradiation facility. With this information the walls were built with a thickness of 125 cm. Special attention was put on the weak points (main door, air conditioning system, etc.) so that the ambient dose outside the facility was below the regulatory limits. Finally, the Radiation Protection Unit carried out a set of measurements in specific points around the installation with an LB6411 neutron monitor and a Reuter-Stokes high-pressure ion chamber to verify experimentally the results of the simulation.

[Extracorporeal lung support in patients with severe respiratory failure secondary to the 2010-2011 winter seasonal outbreak of influenza A (H1N1) in Spain]

OBJECTIVE

To describe the use of extracorporeal membrane oxygenation (ECMO) in refractory respiratory failure.

DESIGN

A prospective, observational, multi-center study was carried out.

SETTING

Intensive Care Units (ICU) in 148 Spanish hospitals.

PATIENTS

Subjects admitted during epidemic weeks 50-52 of 2010 and weeks 1-4 of 2011, receiving respiratory support with ECMO.

MAIN VARIABLES OF INTEREST

Clinical and blood gas features, complications and survival of patients with ECMO.

RESULTS

Out of 300 ICU admitted patients, 239 (79.6%) were mechanically ventilated. ECMO was available in only 5 ICUs. Nine patients were treated with ECMO (3% of the total and 3.2% of the ventilated patients). In 77.7% of the cases some hypoxemia rescue technique was previously used. ECMO was initiated when ARDS proved refractory to standard treatment. ECMO therapy was started a median of 4.5 days after the onset of mechanical ventilation. The median duration of ECMO was 6 days. Veno-venous (VV) ECMO was the most frequent cannulation mode (88.9%). Four patients had complications associated with ECMO therapy. The median ICU and hospital stay was 17 and 29 days, respectively. In five patients (55.5%), ECMO assistance was satisfactory suspended. The ICU and hospital survival rate was 44.4%.

CONCLUSIONS

The use of ECMO in refractory respiratory failure in patients with influenza A (H1N1) is rare in Spain. The hospital survival achieved with its use allows it to be regarded as a possible rescue technique in these patients.

Multivariate near-infrared reflection spectroscopy strategies for ensuring correct labeling at feed bagging in the animal feed industry

A key concern in animal feed factories is guaranteeing the correct labeling of compound feeds. Therefore, due to incorrect labeling, there is an urgent need for new control methods on the claims that can be made. In this study, this question has been tackled with different multivariate classification algorithms based on the near-infrared spectral fingerprint obtained from a given compound feed analyzed in its original physical market presentation form (i.e., cubes, coarse meals, pellets). The objective of this paper is the evaluation of different methods for establishing a separation among 24 feed types. Two linear methods, soft independent modeling of class analogy (SIMCA) and partial least squares (PLS) with two approaches to classification (PLSD and PLS-LDA); and one nonlinear method, support vector machines (SVM), were studied. The database used had the following structure: a first division was made between granules and meals; within these two groups, there was a second division according to three animal species to which the feed was marketed (bovine, ovine, and porcine); within each species there was a third division according to the age or physiological status of the animal (i.e., lactating dairy cattle, starters, etc.). Given the database structure, all the methods were evaluated following two strategies: (1) development of a model composed of the nine classification models corresponding to the structure of the data; and (2) development of a unique model that discriminates among the 24 classes of different feeds. With both strategies the lowest percentage of misclassified samples was achieved with the SVM method (3.96% with strategy 1 and 2.31% with strategy 2). Among the linear methods evaluated, SIMCA yielded the best results, with a percentage of 8.47% misclassified samples with strategy 1 and 4.05% misclassified samples with strategy 2. The results in this study show the ability of near-infrared spectroscopy to make acceptable classifications of feed types based only on spectral information, with differences in performance depending on the multivariate algorithm used.

Advanced nonlinear approaches for predicting the ingredient composition in compound feedingstuffs by near-infrared reflection spectroscopy

For quantitative applications, the most common usage of near-infrared reflection spectroscopy (NIRS) technology, calibration involves establishing a mathematical relationship between spectral data and data provided by the reference. This model may be fairly complex, since the near-infrared spectrum is highly variable and contains physical/chemical information for the sample that may be redundant, and multivariate calibration is usually required. When the relationship to be modeled is nonlinear, classical regression methods are inadequate, and more complex strategies and algorithms must be sought in order to model this nonlinearity. The development of NIRS calibrations to predict the ingredient composition, i.e., the inclusion percentage of each ingredient, in compound feeds is a complex task, due to the nature of the parameters to be predicted and to the heterogeneous nature of the matrices/formulas in which each ingredient participates. The present paper evaluates the use of least squares support vector machines (LSSVM) and two local calibration methods, CARNAC and locally biased regression, for developing NIRS models to predict two of the most representative ingredients in compound feed formulations, wheat and sunflower meal, using a large spectral library of 7523 commercial compound feed samples. For both ingredients, the best results were obtained using CARNAC, with standard errors of prediction (SEP) of 1.7% and 0.60% for wheat and sunflower meal, respectively, and even better results when the algorithm was allowed to refuse to predict 10% of the unknowns. Meanwhile, LSSVM performed less well on wheat (SEP 2.6%) but comparably on sunflower meal (SEP 0.60%), giving results very similar to those reported previously for artificial neural networks. Locally biased regression was the least successful of the three methods, with SEPs of 3.3% for wheat and 0.72% for sunflower meal. All the nonlinear methods improved on the standard approach using partial least squares (PLS), which gave SEPs of 5.3% for wheat and 0.81% for sunflower meal.

Optimization of discriminant partial least squares regression models for the detection of animal by-product meals in compound feedingstuffs by near-infrared spectroscopy

This paper evaluates two multivariate strategies for classifying near-infrared (NIR) spectroscopic data for the detection of animal by-product meals (henceforth generically termed AbP) as an ingredient in compound feedingstuffs. Classification models were developed to discriminate between the presence and absence of animal-origin meals in compound feeds using two forms of discriminant partial least squares (PLS) regression: the algorithms PLS1 and PLS2. The training set comprised 433 commercial feeds, of which 148 contained AbP and the other 285 were stated to be AbP-free. Since the initial set contained unequal numbers of each class, the effect of this imbalance was analyzed by applying the same algorithms to a training set containing equal numbers of AbP-free and AbP-containing samples. The best classification model (97.42% of samples correctly classified), obtained with PLS2, that showed less sensitivity to the use of class-unbalanced sets, was externally validated using a set of 18 samples (10 AbP-containing and 8 AbP-free); all samples were correctly classified, except for one AbP-free sample that was classified as containing AbP (false positive). The results suggest that the application of PLS discriminant analysis to NIR spectroscopic data enables detection of AbP, a feed ingredient banned since the bovine spongiform encephalopathy (BSE) crisis; this confirms the value of NIRS qualitative analysis for product authentication purposes.

Use of artificial neural networks in near-infrared reflectance spectroscopy calibrations for predicting the inclusion percentages of wheat and sunflower meal in compound feedingstuffs

The use of near-infrared reflectance spectroscopy (NIRS) calibrations to predict the ingredient composition in compound feeds (i.e., inclusion percentage of each ingredient) is a complex task, regarding both the nature of the parameters to be predicted, since they are not well-defined chemical entities, and the heterogeneousness of the matrices/formulas in which each ingredient participates. The present paper evaluates the use of nonlinear regression methods, such as artificial neural networks (ANN), for developing NIRS calibrations to predict these parameters. Two of the most representative ingredients in the Spanish compound feed formulations (wheat and sunflower meal) were selected for evaluating ANN possibilities, using a large spectral library comprising a total of 7523 commercial compound feed samples; 7423 were used as training set and 100 as validation set. Three general models of networks were studied: multilayer perceptron with back-propagation training (BP), multilayer perceptron with Levenberg-Maquartd training (LM), and radial basis function nets (RBF); moreover, in accordance with a factorial design, more complex architectures were evaluated gradually, changing the number of hidden layers and hidden neurons, for the determination of the optimal network topology. For both ingredients, the best results were obtained using ANN with BP training, showing prediction error values (SEP) of 2.72% and 0.66% for wheat and sunflower meal, respectively. These SEP values showed a significant improvement (19%-49% for sunflower meal and wheat, respectively) in comparison with those obtained using calibrations developed with linear methods.

[Department of anesthesia, resuscitation and critical care]

The present study describes the impact on the Department of Anesthesiology, Resuscitation and Critical Care of treating the victims of the 11 March terrorist attack, both on the day of the attack and on subsequent days. Of the 182 victims who were hospitalized, 61 had a poor prognosis, 24 had a very poor prognosis, 2 were already dead, and a further 2 died that day. Twenty-seven patients were admitted to the critical care unit. Patients with suspected severe injuries were sent to postanesthesia recovery units, where a second level of triage was performed, allowing patients to be appropriately transferred according to their severity and the necessary interventions to be performed.

Implementation of LOCAL algorithm with near-infrared spectroscopy for compliance assurance in compound feedingstuffs

Seven thousand four hundred and twenty-three compound feed samples were used to develop near-infrared (NIR) calibrations for predicting the percentage of each ingredient used in the manufacture of a given compound feedingstuff. Spectra were collected at 2 nm increments using a FOSS NIRSystems 5000 monochromator. The reference data used for each ingredient percentage were those declared in the formula for each feedingstuff. Two chemometric tools for developing NIRS prediction models were compared: the so-called GLOBAL MPLS (modified partial least squares), traditionally used in developing NIRS applications, and the more recently developed calibration strategy known as LOCAL. The LOCAL procedure is designed to select, from a large database, samples with spectra resembling the sample being analyzed. Selected samples are used as calibration sets to develop specific MPLS equations for predicting each unknown sample. For all predicted ingredients, LOCAL calibrations resulted in a significant improvement in both standard error of prediction (SEP) and bias values compared with GLOBAL calibrations. Determination coefficient values (r(2)) also improved using the LOCAL strategy, exceeding 0.90 for most ingredients. Use of the LOCAL algorithm for calibration thus proved valuable in minimizing the errors in NIRS calibration equations for predicting a parameter as complex as the percentage of each ingredient in compound feedingstuffs.

Characterizing T-cell receptor gamma-variable gene in Aotus nancymaae owl monkey peripheral blood

Gammadelta T lymphocytes have a heterodimeric complex formed by the association of gamma and delta chains as receptor. Proliferation of this lymphocyte population has been observed, when infection by several pathogens such as Mycobacterium tuberculosis and Plasmodium spp. occurs. The New World Monkey Aotus nancymaae has become a very good experimental model for the immunological and physiopathological study of these infectious agents. The A. nancymaae gamma-variable region was characterized from peripheral blood samples by using cDNA and genomic DNA polymerase chain reaction amplification, DNA sequencing, and dot-blot hybridization techniques. Seventeen different T-cell receptor gamma-variable (TCRGV) sequences were obtained. These sequences were distributed among TCRGV subsets 1, 2, or 3, according to human subset classification. Although no subset 4 amplification was obtained, this subset was detected by dot-blot hybridization. The presence of these 4 subsets resembles the behavior displayed by 'gammadelta-low species' (humans and mice), where high diversity among these lymphocytes can be observed. Homologies greater than 70% were found with respect to humans. Sequence convergence between human and A. nancymaae subsets 1 and 3 highlights Aotus as a promising model for studying these lymphocyte functions.

[Prognosis of patients admitted to the coronary or intensive care unita after an out of hospital episode of sudden death]

INTRODUCTION AND OBJECTIVE

Out of hospital sudden death constitutes a major sanitary problem. Early diagnosis and treatment are considered as the most important factors related with short term prognosis. However, there is little information about the outcome of patients admitted to the hospital after a successful recovery from an episode of sudden death outside the hospital. The objective of this study was to analyze the prognosis of patients who initially recovered after an episode of out-of-hospital cardiac arrest and who were admitted to the coronary or intensive care unit.

PATIENTS AND METHODS

The clinical characteristics and outcome of 110 consecutive patients admitted to the coronary and intensive care units after an episode of extrahospital sudden death, who initially recovered with success, were retrospectively studied.

RESULTS

A total of 33 (30%) patients were discharged alive and without severe neurological damage, 67 (61%) patients died before discharge from hospital and 77 (70%) died or presented severe and permanent neurological damage. The latter group versus those who survived was older (63.6 +/- 13.5 vs 55.2 +/- 12.6 years old; p < 0.006) and had a longer delay in the beginning of cardiopulmonary resuscitation (8.3 vs 2.8 min.; p < 0.01). Mortality or severe neurological damage rate was higher in the group of those who had asystolia than in those with ventricular fibrillation in the first ECG (84% vs 55%), in those who arrived to the hospital unconscious (73.7% vs 15.4%) and in those who arrived in functional class IV (81% vs 16.6%).

CONCLUSIONS

Up to 30% of the patients admitted after an episode of extrahospital cardiac arrest were discharged alive and without severe neurological damage. Advanced age, functional class IV and the delay of cardiopulmonary resuscitation are related to a unfavorable outcome.

Pressure-controlled ventilation versus controlled mechanical ventilation with decelerating inspiratory flow

OBJECTIVE

To ascertain whether pressure-controlled ventilation offers any advantage with respect to conventional controlled mechanical ventilation with decelerating flow.

DESIGN

Prospective, comparative study.

SETTING

Intensive care unit.

PATIENTS

Eleven consecutive critically ill adult patients.

MEASUREMENTS AND MAIN RESULTS

Study of respiratory mechanics and arterial blood gases after 30 mins of pressure-controlled ventilation. Repetition of the same measurements after 30 mins of controlled mechanical ventilation with decelerating flow waveform, with equal tidal volumes, using a commercially available mechanical ventilator. Student's t-test for paired comparisons. A lesser maximum inspiratory flow rate was required for pressure-controlled ventilation (55.7 +/- 16 L/sec) than for controlled mechanical ventilation (72 +/- 2 L/sec) (p < .001). Nevertheless, the peak pressures measured in the orotracheal tubes of the patients were higher in pressure-controlled ventilation (20.4 +/- 3.5 cm H2O) than in controlled mechanical ventilation (18.4 +/- 4.8 cm H2O) (p < .05). This model measured pressure in the inspiratory line, providing erroneous information regarding the behavior of pressures in the airway. The peak pressure measured by the ventilator was significantly higher in controlled mechanical ventilation than in pressure-controlled ventilation and was, in addition, reached at initiation of inspiration in ten of 11 patients with controlled mechanical ventilation, while peak pressure measured in the orotracheal tube was invariably reached at the end of the inspiration, both in pressure-controlled ventilation and controlled mechanical ventilation. The rest of the parameters analyzed, including end-inspiratory pressure, mean pressure, intrinsic positive end-expiratory pressure, and arterial blood gases, showed no differences. The difference between quasi-static compliances almost reached statistical significance (72 +/- 25.4 mL/cm H2O in pressure-controlled ventilation vs. 68.8 +/- 24.3 mL/cm H2O in controlled mechanical ventilation; p = .052).

CONCLUSIONS

Our study failed to demonstrate any important difference between pressure-controlled ventilation and controlled mechanical ventilation with decelerating inspiratory flow waveform. The differences in the airway pressures detected by the ventilator are spurious and are due to the place (inspiratory line) where these pressures were measured. The difference between the peak pressure measured in the orotracheal tube has statistical, but not clinical, value and is lower in controlled mechanical ventilation. Based on the limited number of variables we studied and unless the tendency indicated in the quasi-static compliance is demonstrated in the future, we do not believe that pressure-controlled ventilation contributes any uniqueness to the theory or practice of mechanical ventilation.

Interaction between intrinsic positive end-expiratory pressure and externally applied positive end-expiratory pressure during controlled mechanical ventilation

OBJECTIVE

To assess the interaction between intrinsic and externally applied positive end-expiratory pressure (intrinsic PEEP and administered PEEP) in mechanically ventilated patients.

DESIGN

Prospective study.

SETTING

Intensive care unit of a university hospital.

PATIENTS

Twelve consecutive critically ill patients.

INTERVENTIONS

Application of an external PEEP of the same value as the intrinsic PEEP.

MEASUREMENTS AND MAIN RESULTS

We found that when the administered PEEP was increased from 0 to the baseline value of intrinsic PEEP, mean intrinsic PEEP decreased from 6.5 +/- 4.2 (SD) to 1.3 +/- 0.7 cm H2O (p = .001). The mean end-inspiratory pressure was increased from 20.3 +/- 4.6 to 23.1 +/- 6.1 cm H2O (p < .05). The difference between the modification of intrinsic PEEP and the change in the end-inspiratory pressure was not significantly > 0 cm H2O. Thus, the increase in end-inspiratory pressure may be directly attributable to the increase in total PEEP (administered PEEP plus intrinsic PEEP). None of the other measurements of pulmonary mechanics changed (peak pressure, inspiratory resistance, compliance, and trapped-gas volume).

CONCLUSIONS

The administration of positive end-expiratory pressure equal to the intrinsic positive end-expiratory pressure causes the almost total disappearance of the intrinsic positive end-expiratory pressure. When the administered positive end-expiratory pressure does not exceed the intrinsic positive end-expiratory pressure, the former is applied almost in its entirety to the patient's external circuit. The administration of positive end-expiratory pressure without prior quantification of the intrinsic positive end-expiratory pressure results in an overestimation of the beneficial effects of the administered positive end-expiratory pressure on the quasi-static compliance.

Right ventricular systolic time intervals determined by means of a pulmonary artery catheter

OBJECTIVES

To evaluate the right ventricular systolic time interval as an index of right ventricular function and also to ascertain whether the right ventricular ejection fraction may be determined by means of a conventional pulmonary artery catheter.

DESIGN

Prospective study.

SETTING

Intensive care unit.

PATIENTS

Eight, consecutive critically ill adult patients.

METHODS

Simultaneous blind measurements, performed by two investigators, of the right ventricular systolic time interval and right ventricular ejection fraction, determined by means of a pulmonary artery catheter. Two studies, separated by an interval of 24 hrs, per patient. Linear regression analysis. Multiple regression test.

RESULTS

Of the 16 studies performed, two determinations of right ventricular systolic time intervals were technically inadequate. In the remaining 14 valid studies, we found one close linear correlation between the right ventricular ejection fraction and the preejection period/ejection time quotient measured using the simultaneous display of the electrocardiogram (EKG) and pulmonary arterial pressure curve (r2 = .90, p < .001, right ventricular ejection fraction = 68.96-60.59 x [right ventricular preejection period/right ventricular ejection time]). The method proved to be simple, very accurate, with little interobserver variation (8.09 +/- 10.6% interobserver variation for right ventricular preejection period/right ventricular ejection time) and provided adequate information regarding situations in which the performance of the right ventricle is modified in a given patient. The right ventricular preejection period/right ventricular ejection time quotient was the only variable that displayed a significant relationship with the right ventricular ejection fraction in the multivariate analysis (p < .001).

CONCLUSIONS

Right ventricular systolic time intervals, measured using the simultaneous display of the pulmonary artery catheter curve and EKG, provide adequate information regarding right ventricle performance in critically ill patients. The close linear correlation between the right ventricular preejection period/right ventricular ejection time quotient and the right ventricular ejection fraction enables the investigator to estimate, with a high degree of accuracy, the right ventricular ejection fraction and the values derived from the preload of the right ventricle, without the need for a modified pulmonary artery catheter.