RU-2861349-C1 - METHOD FOR ASSESSING LOCAL CONTRACTILITY OF LEFT VENTRICLE OF HEART IN PATIENTS IN PRONE POSITION

RU2861349C1RU 2861349 C1RU2861349 C1RU 2861349C1RU-2861349-C1

Abstract

FIELD: medicine. SUBSTANCE: invention relates to anaesthesiology and intensive care, and can be used for monitoring the local contractility of the left ventricle of the heart in patients in the prone position. For this purpose, an ultrasound examination is performed in B-mode, wherein a low-frequency ultrasound probe is placed in the region of the 8th-9th left intercostal space along the line as shown in Fig. 1. Next, the angle of inclination of the probe is changed in the range of 1-15° to the sagittal plane, and the left ventricle is visualised in a two-chamber view of the heart in a cross-section. EFFECT: reducing the risk of hypoxic damage to internal organs and the brain, including irreversible changes, in this category of patients by assessing the local contractility of the left ventricle using an ultrasound method in a specific manner. 1 cl, 1 dwg, 1 ex

Inventors

Kuvshinov Ivan Aleksandrovich
Voennov Oleg Viacheslavovich
Matreshkin Vadim Aleksandrovich

Dates

Publication Date: 20260505
Application Date: 20250711

Claims (1)

A method for conducting an ultrasound examination of the heart when assessing local contractility of the myocardium of the left ventricle of the heart in patients in a prone position, including conducting an ultrasound examination in B-mode, characterized in that a low-frequency ultrasound sensor is installed in the region of the 8-9 intercostal space on the left along the line as indicated in Fig. 1, the angle of inclination of the sensor is changed in the range of 1-15° to the sagittal plane and the left ventricle is visualized in a two-chamber projection of the heart in a cross section.

Description

The invention relates to medicine, in particular to anesthesiology and resuscitation, and can be used to monitor local contractility of the left ventricle of the heart of patients in critical condition. A method for non-invasively assessing the local contractility of the left ventricle of the heart is known, in which the patient is placed in a supine position, a low-frequency ultrasound sensor is installed in the projection area of the apex of the left ventricle of the heart (apical region), and visualized in B-mode. A 4-chamber image of the heart is obtained by rotating the sensor 45° counterclockwise so that its marker is facing the left shoulder joint, a 2-chamber image of the heart is obtained, the anterior and inferior walls of the left ventricle are visualized, local contractility of the walls of the left ventricle of the heart is visually assessed and a conclusion is made about the presence or absence of local contractility of the myocardium of the left ventricle (Echocardiography. A Practical Guide / Alisdair Riding; translated from English. - 4th ed. - M .: MEDpress-inform, 2016. - 280 p.: ill. + 1 CD. ISBN 978-5-00030-334-4). A significant drawback of the known method is its inability to assess local left ventricular contractility in patients in the prone position, as the apical region of a prone patient is inaccessible for ultrasound transducer placement. To access the apical region, the patient must be placed in the supine position, which may worsen their condition. The prone position is used in intensive care for patients with acute respiratory distress syndrome (ARDS) to improve oxygenation. In the patient's best interests, the actual duration of prone positioning can reach 16-24 hours per session (Nasa, P. et al. Expert consensus statements for the management of OVID-19-related acute respiratory failure using a Delphi method. Crit Care 2021; 25:106). Prematurely turning the patient from the prone position to the back can worsen oxygenation, increase the likelihood of hypoxic damage to internal organs and the brain, and even lead to irreversible changes. The objective of the invention is to improve the safety of non-invasive assessment of left ventricular contractility in a patient in the prone position. The technical result is a reduction in the risk of hypoxic damage to internal organs and the brain, including irreversible changes, when assessing local contractility of the left ventricle using ultrasound, and an increase in the effectiveness of treatment. The technical result is achieved by installing a low-frequency ultrasound sensor on the patient's body, which is in the prone position, in the region of the 8-9 intercostal space on the left along the line as shown in Figure 1, in B-mode, changing the angle of inclination of the sensor in the range of 1-15° to the sagittal plane, visualizing the 2-chamber position of the heart, visualizing the activity of the left ventricle and assessing the local contractility of the left ventricle of the heart. The method is implemented as follows. With the patient in the prone position, a low-frequency ultrasound transducer with gel applied to it is inserted into the 8th-9th intercostal space on the left along line (1) in Fig. 1. This eliminates the acoustic shadow created by the left pleural sinus, which prevents visualization of deeper organs and tissues. The transducer tilt angle is varied within a range of 1° to 15° relative to the sagittal plane, providing B-mode visualization of the two-chamber position of the heart in a cross-section of the left ventricle scan. This determines the maximum acoustic window, which allows visualization of the left ventricle in the two-chamber projection of the heart in B-mode in a cross-section, the same as with the ultrasound transducer positioned in the apical two-chamber position. Left ventricular activity is visualized, and local contractility of the left ventricle is assessed. The position of the ultrasound sensor in the 8-9th intercostal space on the left on the line indicated in Figure 1, the choice of the angle of inclination of the ultrasound sensor in the range of 0-15° to the sagittal plane ensures visualization of the heart cavities taking into account the individual anatomical features of patients in the prone position. Example. Patient V., 43, with a body mass index of 26 kg/ m2 , was admitted to the anesthesiology and intensive care unit with symptoms of acute respiratory failure for emergency diagnostic and treatment procedures. Based on clinical, instrumental, and laboratory examination data, the patient was diagnosed with mild adult respiratory distress syndrome (ARDS). Due to the worsening symptoms of acute respiratory failure against the background of sequential low- and high-flow oxygen therapy, it was decided to transfer the patient to the prone position. In the prone position, the patient's oxygen saturation increased to 94-95%. The patient spent 16 hours in the prone position over the course of