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

  • Osman D
  • Monnet X
  • Castelain V
 et al. 
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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 < 30 mL m(-2). RESULTS: Right ventricular failure was present in 9.6% of patients. Mortality was 68% at day-90 with no difference between patients with RVF (RVF+) and without RVF (71 vs. 67%, respectively). SAPS II, PaO(2)/FiO(2) and PaCO(2) were similar in both groups. Tidal volume and I/E ratio were significantly higher in RVF+ (9.7 +/- 2.8 vs. 8.6 +/- 1.8 ml m(-2) and 0.7 +/- 0.5 vs. 0.5 +/- 0.2). Plateau pressure tended to be higher in RVF+ (28 +/- 6 vs. 25 +/- 6 cmH(2)O, NS). In multivariate analysis, PaO(2)/FiO(2), mean arterial pressure, arterial pH, SvO(2), MPAP and presence of CVP > 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.

Author-supplied keywords

  • *Respiratory Distress Syndrome, Adult/co [Complica
  • *Ventricular Dysfunction, Right/co [Complications]
  • *Ventricular Dysfunction, Right/di [Diagnosis]
  • Aged
  • Central Venous Pressure
  • Female
  • France/ep [Epidemiology]
  • Humans
  • Incidence
  • Intensive Care Units
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Pulmonary Heart Disease/co [Complications]
  • Pulmonary Heart Disease/di [Diagnosis]
  • Respiratory Distress Syndrome, Adult/mo [Mortality
  • Respiratory Function Tests
  • Risk Factors
  • Stroke Volume
  • Ventricular Dysfunction, Right/ep [Epidemiology]

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  • D Osman

  • X Monnet

  • V Castelain

  • N Anguel

  • J Warszawski

  • J L Teboul

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