November 29, 2025
Objective: To evaluate the cardiopulmonary effect during prone position (PP) on right ventricular (RV) recovery in coronavirus disease-2019-related acute respiratory distress syndrome (C-ARDS) through transesophageal echocardiography (TEE).
Methods: This prospective study included 30 moderate-to-severe C-ARDS patients who were treated with PP in the first 48 h of invasive mechanical ventilation support. TEE was performed at three time points: before PP (T0), during the first hour of PP (T1), and during the first hour after returning to the supine position (T0 + 24 h) (T2) following 23 hours of PP treatment. RV end-diastolic area/left ventricular (LV) end-diastolic area (RVEDA/LVEDA), tricuspid annular plane systolic excursion (TAPSE), and LV end-systolic eccentricity index were used as the primary measures of RV function. Pulmonary effects of PP were evaluated as secondary outcomes, including PaO₂/FiO₂, driving pressure (dP), static compliance (Cstat), mechanical ventilation parameters, and their association with 28-day survival. Tissue DO₂ was also evaluated as a secondary outcome and was calculated using cardiac output measured by TEE.
Results: With the cardiopulmonary effects of PP, the decrease in RVEDA/LVEDA, the increase in TAPSE, PaO₂/FiO₂, and Cstat, and the decrease in dP were statistically significant (P < 0.05). The Cstat value associated with 28-day survival showed decreased mortality for each unit increase. The statistically significant Cstat cut-off value for survival was 37.
Conclusion: PP can improve RV recovery and oxygenation, but it is not always accompanied by increased survival. An increase in Cstat may improve survival without the development of RV dysfunction while maintaining heart-lung interaction.
Keywords: ARDS, lung compliance, prone position, respiratory mechanics, right ventricular, transesophageal echocardiography.
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