RESUMEN
Right ventricular (RV) dysfunction is common in acute respiratory failure and associated with worse outcomes, but it can be difficult to detect in the ICU setting. Speckle-tracking echocardiography (STE) can identify early changes in RV systolic function and be quantified as systolic strain. We measured the feasibility of RV global longitudinal systolic strain (RV GLS) in respiratory failure patients and its association with clinical outcomes. DESIGN: Retrospective cohort. SETTING: Two tertiary hospital medical ICUs in Providence, RI, from March 2015 to January 2018. PATIENTS: Two hundred twenty-three patients with acute respiratory failure requiring mechanical ventilation (MV) with available echocardiograms. MEASUREMENTS AND MAIN RESULTS: Clinical data were extracted from medical records. RV GLS was measured via STE (TOMTEC, Chicago, IL), along with standard echocardiographic measurements by two independent readers blinded to outcomes. The average age was 65 years (range, 21-90 yr), 121 (54%) were men, and the most common etiology of respiratory failure was pneumonia (n = 83, 37%). The average RV GLS was -16% (sd ± 7). The intraobserver correlation coefficients were 0.78 and 0.94, whereas the interobserver correlation coefficient was 0.61 for RV GLS. In the majority of echocardiograms (n = 178, 80%), all wall segments were tracked appropriately by operator visual inspection. Worse RV GLS was associated with greater hospital mortality (odds ratio, 1.03; 95% CI, 1.00-1.07; p = 0.03), such that every 1% decrement in RV GLS was associated with up to a 7% increase in the risk of death. RV GLS was 90% sensitive for the detection of RV dysfunction compared with tricuspid annular plane systolic excursion. CONCLUSIONS: The measurement of RV GLS by STE in subjects on MV is feasible, reproducible, and sensitive for the detection of RV dysfunction. RV GLS may predict poor outcomes in acute respiratory failure.
RESUMEN
Sleep disruption among adolescents represents a major public health concern, and social media use may play an important role in affecting sleep and subsequent mental health. While prior studies of youth sleep and mental health have often focused on social media use frequency and duration, adolescents' emotional experiences related to social media have been underexplored, particularly among clinically acute populations. This study offers a preliminary investigation of associations among negative emotional experiences using social media, sleep disturbance, and clinical symptom severity in a sample of psychiatrically hospitalized youth. A sample of 243 adolescents (Mage = 15.34) completed self-report measures at a single time point. Measures assessed social media use, including frequency and duration, subjective experiences of use, and emotional responses to use, as well as sleep disturbance and clinical symptom severity, including suicidal ideation, internalizing symptoms, and attention problems. Results revealed that more frequent negative emotional responses to social media use were linked to greater sleep disturbance and higher clinical symptom severity. Furthermore, sleep disturbance mediated the relation between negative emotional responses to social media and clinical symptom severity. While gender differences were revealed in characteristics of social media use, sleep disturbance, and clinical outcomes, the associations among these constructs did not vary across gender groups. Overall, these findings highlight sleep disturbance as a potential mechanism through which negative emotional experiences on social media may impact clinical symptoms in psychiatrically vulnerable youth.
