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Intensive Care Med. 2009 Jan;35(1):69-76. doi: 10.1007/s00134-008-1307-1. Epub 2008 Oct 7.

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

Author information

1
Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-11 Sud, Le Kremlin-Bicêtre, France.

Abstract

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.

PMID:
18839137
DOI:
10.1007/s00134-008-1307-1
[Indexed for MEDLINE]

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