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Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact

Intensive care medicine, 2016-05, Vol.42 (5), p.862-870 [Peer Reviewed Journal]

Springer-Verlag Berlin Heidelberg and ESICM 2015 ;COPYRIGHT 2016 Springer ;Springer-Verlag Berlin Heidelberg and ESICM 2016 ;ISSN: 0342-4642 ;EISSN: 1432-1238 ;DOI: 10.1007/s00134-015-4141-2 ;PMID: 26650055

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Title:
Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact
Author: Mekontso Dessap, Armand ; Boissier, Florence ; Charron, Cyril ; Bégot, Emmanuelle ; Repessé, Xavier ; Legras, Annick ; Brun-Buisson, Christian ; Vignon, Philippe ; Vieillard-Baron, Antoine
Subjects: Acute Disease ; Acute respiratory distress syndrome ; Anesthesiology ; Cor pulmonale ; Critical Care Medicine ; Echocardiography, Transesophageal ; Emergency Medicine ; Female ; France ; Humans ; Intensive ; Intensive Care Units ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Middle Aged ; Mortality ; Pain Medicine ; Pediatrics ; Pneumology/Respiratory System ; Predictive Value of Tests ; Prevalence ; Prognosis ; Prospective Studies ; Pulmonary Heart Disease - diagnostic imaging ; Pulmonary Heart Disease - epidemiology ; Pulmonary Heart Disease - etiology ; Respiration, Artificial - adverse effects ; Respiratory distress syndrome ; Respiratory Distress Syndrome, Adult - therapy ; Risk Factors ; Seven-Day Profile Publication ; Treatment Outcome ; United Kingdom
Is Part Of: Intensive care medicine, 2016-05, Vol.42 (5), p.862-870
Description: Rationale Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP). Objectives To determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP. Methods This was a prospective study in which 752 patients with moderate-to-severe ARDS receiving protective ventilation were assessed using transesophageal echocardiography in 11 intensive care units. The study cohort was randomly split in a derivation ( n = 502) and a validation ( n = 250) cohort. Measurements and main results ACP was defined as septal dyskinesia with a dilated RV [end-diastolic RV/left ventricle (LV) area ratio >0.6 (≥1 for severe dilatation)]. ACP was found in 164 of the 752 patients (prevalence of 22 %; 95 % confidence interval 19–25 %). In the derivation cohort, the ACP risk score included four variables [pneumonia as a cause of ARDS, driving pressure ≥18 cm H 2 O, arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) ratio <150 mmHg, and arterial carbon dioxide partial pressure ≥48 mmHg]. The ACP risk score had a reasonable discrimination and a good calibration. Hospital mortality did not differ between patients with or without ACP, but it was significantly higher in patients with severe ACP than in the other patients [31/54 (57 %) vs. 291/698 (42 %); p = 0.03]. Independent risk factors for hospital mortality included severe ACP along with male gender, age, SAPS II, shock, PaO 2 /FiO 2 ratio, respiratory rate, and driving pressure, while prone position was protective. Conclusions We report a 22 % prevalence of ACP and a poor outcome of severe ACP. We propose a simple clinical risk score for early identification of ACP that could trigger specific therapeutic strategies to reduce RV afterload.
Publisher: Berlin/Heidelberg: Springer Berlin Heidelberg
Language: English
Identifier: ISSN: 0342-4642
EISSN: 1432-1238
DOI: 10.1007/s00134-015-4141-2
PMID: 26650055
Source: MEDLINE
ProQuest Central

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Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact

Springer-Verlag Berlin Heidelberg and ESICM 2015 ;COPYRIGHT 2016 Springer ;Springer-Verlag Berlin Heidelberg and ESICM 2016 ;ISSN: 0342-4642 ;EISSN: 1432-1238 ;DOI: 10.1007/s00134-015-4141-2 ;PMID: 26650055

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