Is right ventricular function the one that matters in ARDS patients? Definitely yes

Abstract

Since the beginning of the 1980s, intensivists have known that acute respiratory distress syndrome (ARDS) is strongly associated with pulmonary hypertension and right ventricular (RV) dysfunction [1, 2]. Three phenomena promote this. First, lung damage per se, which combines alveolar injury with capillary destruction and obstruction by clots. Second, remodeling of the pulmonary circulation, defined as a muscularization of normally nonmuscularized vessels, mediated by hypoxemia and hypercarbia, and finally, positive pressure ventilation, which increases the distending pressure of the lung and thus crushes the pulmonary capillaries. These phenomena are reversible, except for pulmonary capillary destruction, which was especially observed when tidal volume was adjusted to correct the PaCO2, and so the plateau pressure (Pplateau) is not limited. During this period, RV failure was frequent and associated with high mortality [24]. In particular, Jardin et al. found in a series of 23 patients an incidence of acute cor pulmonale (ACP) as high as 61% with 100% mortality in the most severe forms [2]. ACP is considered to reflect RV dysfunction due to an acute increase in RV afterload, as in ARDS. Its definition is echocardiographic: RV dilatation in combination with paradoxical septal motion during systole.