Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome

• Published in: Intensive care medicine 2009, Vol.35 (1), p.69-76
• Main Authors: Osman, David, Monnet, Xavier, Castelain, Vincent, Anguel, Nadia, Warszawski, Josiane, Teboul, Jean-Louis, Richard, Christian
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Catheters; Central Venous Pressure; Cor pulmonale; Critical Care Medicine; Emergency and intensive respiratory care; Emergency Medicine; Female; France - epidemiology; Hemodynamics; Humans; Incidence; Intensive; Intensive care medicine; Intensive Care Units; Life Sciences; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Original; Pain Medicine; Pediatrics; Pneumology/Respiratory System; Prognosis; Proportional Hazards Models; Pulmonary arteries; Pulmonary Heart Disease - complications; Pulmonary Heart Disease - diagnosis; Pulmonary hypertension; Respiratory distress syndrome; Respiratory Distress Syndrome, Adult - complications; Respiratory Distress Syndrome, Adult - mortality; Respiratory Function Tests; Risk Factors; Stroke Volume; Veins & arteries; Ventilators; Ventricular Dysfunction, Right - complications; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - epidemiology
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-008-1307-1

Objective To analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS). Patients and methods A total of 145 ARDS patients included in the previously published French Pulmonary Artery Catheter (PAC) study were randomly assigned to receive a PAC. All patients were ventilated according to a strategy aimed at limiting plateau pressure. The RVF was defined by the concomitant presence of: (1) a mean pulmonary artery pressure (MPAP) > 25 mmHg, (2) a central venous pressure (CVP) higher than pulmonary artery occlusion pressure (PAOP) and (3) a stroke volume index  PAOP, but not RVF, were independently associated with day-90 mortality. Conclusion In this group of patients investigated early in the course of ARDS and ventilated according to a strategy aimed at limiting plateau pressure, the presence of RVF was about 10%. Unlike MPAP and the presence of CVP > PAOP, RVF at this early stage did not appear as an independent factor of mortality.