Tricuspid annular plane systolic excursion (TAPSE) as a noninvasive echo marker in evaluating prone position effectiveness for COVID-19 patients with severe ARDS—a case series

Background: Increased pulmonary arterial compliance (CPA) and pulmonary vascular resistance (PVR) can result in right heart failure in the coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS), leading to acute cor pulmonale (ACP). We are studying the impact of prone position and mechanical ventilation on right ventricular (RV) function in ARDS COVID-19 patients. Specifically, we use an echocardiography marker to evaluate blood flow resistance in the pulmonary circuit while patients are prone. Case Description: During the COVID-19 pandemic from 2020 to 2023, we observed six critically ill patients suffering from severe COVID-19 ARDS treated with invasive controlled mechanical ventilation in the Intensive Care Unit at General Hospital Gradiska. After thoroughly examining the medical database, we identified six patients who met our research criteria. According to the Helsinki Declaration, the University Clinical Center of the Republic of Srpska ethics committee approved the observational retrospective study. All of the observed patients were critically ill COVID-19 patients on mechanical ventilation. There was a group of survivors called Group S (n=3). Another group, called Group D, comprises deceased individuals (n=3). After investigating the potential risk of mortality associated with ACP in patients diagnosed with ARDS, it was concluded that all three deceased patients (Group D) had a segmental pulmonary thromboembolism (PTE), which was confirmed by computed tomography (CT), in contrast to all three surviving patients (Group S), in whom no pulmonary embolism was detected. Thromboembolic obstruction of pulmonary blood flow did not significantly reduce RV afterload as in surviving patients. The mean value of the tricuspid annular plane systolic excursion (TAPSE) echo parameter was lower after pronation in the deceased group than in the surviving patients (P=0.03, Wilcoxon Signed Rank Test). Conclusions: The study highlights using TAPSE as an easy and valuable echocardiographic marker to monitor RV function in pre- and post-pronation ARDS COVID-19 patients with potential implications for clinical outcomes.