Cost of Training Crisis: Anaesthetics.

Abstract

BACKGROUND: The pneumonitis associated with coronavirus disease 2019 (COVID-19) infection impacts the right ventricle (RV). However, the association between the disease severity and right ventricular systolic function needs elucidation. METHOD: We conducted a retrospective study of 108 patients admitted to critical care with COVID-19 pneumonitis to examine the association between tricuspid annular plane systolic excursion (TAPSE) by transthoracic echocardiography as a surrogate for RV systolic function with PaO(2)/FiO(2) ratio as a marker of disease severity and other respiratory parameters. RESULTS: The median age was 59 years 51, 66], 33 (31%) were female, and 63 (58%) were mechanically ventilated. Echocardiography was performed at a median of 3 days 2, 12] following admission to critical care. The PaO(2)/FiO(2) and TAPSE medians were 20.5 14.4, 32.0] and 21 mm 18, 24]. There was a statistically significant, albeit weak, association between the increase in TAPSE and the worsening of the PaO(2)/FiO(2) ratio (r(2) = 0.041, p = 0.04). This association was more pronounced in the mechanically ventilated (r(2) = 0.09, p = 0.02). TAPSE did not correlate significantly with FiO(2), PaO(2), PaCO(2), pH, respiratory rate, or mechanical ventilation. Patients with a TAPSE = 17 mm had a considerably worse PaO(2)/FiO(2) ratio than a TAPSE 17 mm with reasonable sensitivity (67%) and specificity (68%). CONCLUSION: In patients admitted to critical care with COVID-19 pneumonitis, TAPSE increased as the disease severity worsened early in the course of the disease, especially in the mechanically ventilated. A TAPSE within the normal range is not necessarily reassuring in early COVID-19 pneumonitis.