Using echocardiography to investigate the incidence of RV dysfunction in ventilated patients with COVID-19.
INTRODUCTION Following the first reported cases in China, there has been a worldwide pandemic of a new virus commonly known as, Coronavirus. The virus causes a number of conditions including; cough, high temperature, painful muscles and breathing difficulties. The disease the virus causes is known as Coronavirus Disease 2019 (COVID-19). In the majority of cases these symptoms will get better without any treatment and without needing admission to hospital. In a small proportion of cases, the symptoms can be so bad that patients will need admission to hospital. Of the group admitted to hospital an even smaller group (approximately 5% of all confirmed coronavirus cases) will need treatment in an intensive care unit. This is often for severe breathing difficulties and sometimes requires the patient to be put on a breathing machine. The breathing machine is also known as a life support machine or ventilator and needing its support is known as 'ventilation' or 'being ventilated'. In other conditions causing severe breathing difficulties requiring ventilation, pressure can be put on the right side of the heart ('the right heart \[or right ventricle\];' the part of the heart pumping blood to the lungs). This can cause the right heart to fail, struggling to pump blood forward and with a build-up of back pressure. This is also known as right heart (or ventricular) dysfunction. Patients needing ventilated, who develop problems with the right heart, are less likely to survive their intensive care stay. No scientists have examined whether patients with COVID-19, requiring ventilation, have problems with their right heart. METHODS Using noninvasive ultrasound scans of the heart (echocardiography) the investigators will explore whether ventilated patients in intensive care have problems with their right heart. The investigators will also collect blood samples to look for damage to the heart during this time. AIMS The aim of this study is to determine how many patients with COVID-19 needing ventilation have problems with the right heart. The investigators will explore if those patients with right heart problems are more likely to die by 30 days following their intensive care admission. By examining clinical data, the investigators will also look to see if any other conditions or treatments increase the risk of right heart problems. By identifying right heart problems in these patients, the investigators may be able to guide future studies to determine if any specific treatments targeted at protecting the right heart can improve outcomes in this patient group.
Study Type
OBSERVATIONAL
Enrollment
150
Echocardiography will be undertaken by a range of appropriately competent practitioners including; intensive care clinicians, cardiologists and specialist echocardiographers. Imaging obtained will be in keeping with the protocol required for a Focused Intensive Care Echo (FICE) scan and should include ECG monitoring at all times. A focused dataset will be used to answer the primary outcome. If available and the echocardiographers competency and experience permit, further measures of RV function will be obtained at this time.
Aberdeen Royal Infirmary
Aberdeen, United Kingdom
RECRUITINGUniveristy Hospital, Ayr
Ayr, United Kingdom
RECRUITINGThe prevalence of RV dysfunction in ventilated patients with COVID-19
RV dysfunction will be defined as Trans Thoracic Echo (TTE) evidence of RV dilatation along with the presence of septal flattening (in systole, diastole or both).
Time frame: Any timepoint from eligibility (ventilation for more than 48 hours) to 14 days following tracheal intubation and positive pressure ventilation.
Association of RV dysfunction with 30-day mortality.
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
Association of ARDS and RV dysfunction
Time frame: At time of echocardiography
Association of micro/macro thrombi and RV dysfunction
Time frame: At time of echocardiography
The association of direct myocardial injury and RV dysfunction
Time frame: At time of echocardiography
The association of ventilation and RV dysfunction
Time frame: At time of echocardiography
Association of ARDS and 30-day mortality
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
Association of micro/macro thrombi and 30-day mortality
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
Association of direct myocardial injury and 30-day mortality
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
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Golden Jubilee National Hospital
Clydebank, United Kingdom
RECRUITINGDumfries and Galloway Royal Infirmary
Dumfries, United Kingdom
RECRUITINGUniversity Hospital Hairmyres
East Kilbride, United Kingdom
RECRUITINGQueen Elizabeth University Hospital
Glasgow, United Kingdom
RECRUITINGGlasgow Royal Infirmary
Glasgow, United Kingdom
RECRUITINGRaigmore Hospital
Inverness, United Kingdom
RECRUITINGUniversity Hospital, Crosshouse
Kilmarnock, United Kingdom
RECRUITINGRoyal Alexandra hospital
Paisley, United Kingdom
RECRUITING...and 1 more locations
Association of ventilation and 30-day mortality
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
The difference in NP levels between patients with, and patients without, RV dysfunction.
Time frame: At time of echocardiography
The difference in hsTn between patients with, and patients without, RV dysfunction.
Time frame: At time of echocardiography
Association between hsTn and 30-day mortality in patients with, and patients without, RV dysfunction
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation
Association between NP levels and 30-day mortality in patients with, and patients without, RV dysfunction
Time frame: Up to 30-days following intubation and intermittent positive pressure ventilation