Aims

To evaluate the feasibility of a transthoracic echocardiogram using an apical‑subcostal protocol in invasive mechanical ventilation (IMV) and prone position.

Methods

Prospective study of adults who required a prone position during IMV. A pillow was placed only under theleft hemithorax in the prone position to elevate and ease the apical and subcostal windows. A critical care cardiologist(prone group) acquired and evaluated the images using the apical‑subcostal protocol. Besides, we used ambulatoryechocardiograms performed as a comparative group (supine group).

Results

86 patients were included, 43 in the prone and 43 in the supine. In the prone group, the indication to per‑form an echocardiogram was hemodynamic monitoring. All patients were ventilated with protective parameters,and the mean end‑expiratory pressure was 10.6 cmH2O. The protocol was performed entirely in 42 of 43 patientsin the prone group because one patient did not have any acoustic window. In the 43 patients in the prone group ana‑lyzed and compared to the supine group, global biventricular function was assessed in 97.7% (p = 1.0), severe heartvalve disease in 88.4% (p = 0.055), ruled out of the presence of pulmonary hypertension in 76.7% (p = 0.80), pericardialeffusion in 93% (p = 0.12), and volume status by inferior vena cava in 93% (p = 0.48). Comparing prone versus supineposition, a statistical difference was found when evaluating the left ventricle apical 2‑chamber view (65.1 versus 100%,p < 0.01) and its segmental function (53.4 versus 100%, p < 0.01).

Conclusion

The echocardiogram using an apical‑subcostal protocol is feasible in patients in the IMV and proneposition.