ORAL COMMUNICATION | Right ventricular function across different respiratory support strategies in severe community-acquired pneumonia

Introduction. Severe community-acquired pneumonia (CAP) often causes acute respiratory failure. The right ventricle (RV) is sensitive to increases in pulmonary vascular resistance from hypoxemia, hypercapnia, and acidosis. Non-invasive respiratory support may add positive pressure and raise RV afterload. In PSI IV–V CAP, we evaluated (1) the association between oxygenation modality—non-invasive ventilation (NIV), high-flow nasal cannula (HFNC), and Venturi mask—and RV systolic function, measured by tricuspid annular plane systolic excursion (TAPSE) and lateral systolic velocity (TDI); and (2) the relationship with length of stay (LOS).

Materials and Methods. Monocentric observational study in an Internal Medicine Unit. Consecutive severe CAP patients were enrolled; we excluded conditions independently altering RV load. NIV was pressure-support with PEEP; HFNC used high flow and FiO₂; Venturi masks delivered oxygen without positive pressure.

Results. Seventy patients: NIV 21, HFNC 22, Venturi mask 27. RV performance differed across groups (Kruskal–Wallis p<0.001). NIV had the lowest TAPSE/TDI; the Venturi mask preserved mechanics. LOS was longer with NIV and HFNC than with a Venturi mask (p<0.001). TAPSE and TDI inversely correlated with LOS.

Conclusions. In severe CAP, respiratory strategy influences RV systolic function and hospitalization. Early RV-focused echocardiography may support hemodynamically protective oxygenation choices in Internal Medicine.