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

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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, PaO2/FiO2 and PaCO2 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 cmH2O, NS). In multivariate analysis, PaO2/FiO2, mean arterial pressure, arterial pH, SvO2, 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.

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Correspondence to Christian Richard.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1308-0.

Appendix

Appendix

The following were members of the French Pulmonary Artery Catheter Study Group: Steering Committee: C. Richard, L. Brochard, JF. Dhainaut, D. Dreyfuss, JY. Fagon, F. Lemaire, H. Logerot, A. Mercat, F. Saulnier, JL. Teboul, J. Warszawski. Data and Safety monitoring committee. C. Com Nougue, L. Fleury, JR. Legall, C. Melot.

Participating centers and investigators: Agen, Hôpital d’Agen: B. Galiacy; F. Plouvier, Amiens, Hôpital d’Amiens Sud: B. de Cagny, A. Sarraj, M. Slama; Amiens, Hôpital d’Amiens Sud: C. Dayen, V. Jounieaux, I. Mayeux; Argenteuil, Hôpital-Victor Dupouy: G. Bleichner, H. Mentec, JP. Sollet; Bordeaux, Hôpital Pellegrin: JF. Cochard, A. Léger, L. Petit, C. Pinaquy; Boulogne sur Mer, Hôpital du Général Duchenne: G. Brunin, P. Ducq, R. Pordes; Brest, Hôpital Cavale Blanche: E. L’Her, M. Moriconi, A. Renault; Brive, Centre Hospitalier: P. Chevallier, E. Karam; Clamart, Hôpital-Antoine Béclère: O. Axler, F. Brivet, B. Megarbane; Cambrai, Centre Hospitalier Général: P. Ducq, Ph. Morel, C. Dupres, Ch. Caulry; Colombes, Hôpital-Louis Mourier: A. Boyer, D Dreyfuss, E. Pigne, A. Salah; Créteil, Hôpital Henri Mondor: M. Fartoukh, JC. Lacherade; L. Brochard, F. Lemaire, C. Brun-Buisson Dunkerque, Hôpital Général: P. Martin, S. Moulront; Grenoble, Hôpital Michallon: A. Bonadona, D. Barnoud, R. Hamidfar-Roy, P. Pavese, C. Schwebel, T. Stouls; Le Kremlin Bicêtre, Hôpital de Bicêtre: N. Anguel, V. Castelain, A. Mercat, C. Richard, JL. Teboul, D. Wermert; Lens, Hôpital Schaffner: C. Boulle, C. Poisson, D. Thevenin, L. Tronchon; Lille, Hôpital Calmette: S. Beague, T. Onimus, F. Saulnier, S. Nseir; Lille, Hôpital Roger Salengro: C. Chopin, T. Desmettre, M. Jourdain; Nancy, Hôpital Central: PE. Bollaert, B. Levy, P. Gawalkiewicz; Niort, Hôpital de Niort: P. Charlot; Nîmes, Hôpital Gaston Doumergues: C. Arich, N. Balmes, C. Bengler, JE. De la Coussaye, C. Gervais; Orléans, Hôpital de la Source: N. Bercault, T. Boulain, C. Fleury, K. Kuteifan, I. Runge; Paris: Hôpital Bichat: JC. Lacherade, F. Schortgen, JF. Timsit, M. Wolff – Hôpital Bichat: J. Chastre, A. Combes, C. Gibert – Hôpital Boucicaut N. Deye, JL. Diehl, E. Guérot, J. Labrousse – Hôpital Broussais: JY. Fagon, A. Novara – Hôpital Cochin: A. Cariou; Hôpital Européen Georges Pompidou: JL. Diehl, JY. Fagon, E. Guerot, J. Labrousse, G. Meyer, A. Novara, C. Ract, O. Sanchez – Hôtel Dieu A. Gaubel, G. Huchon, A. Lefebvre, A Rabbat, B. Vincent – Hôpital Laënnec: G. Meyer, O. Sanchez – Hôpital Lariboisière: F. Baud, A. Delahaye, R. Galliot, D. Goldran-Toledano, P. Gueye, B. Megarbane – Hôpital Pitié-Salpêtrière: M. Fartouk, Y. Lefort, T. Similowski; Quimper, Hôpital Laënnec: M. Coloigner, JL. Frances, M. Moriconi; Saint-Denis, Hôpital de La Fontaine: M. Bohus, G. Moret, A. Rhaoui; Saint-Germain-en-Laye, CHI Poissy-Saint-Germain-en-Laye: JL. Ricôme; Strasbourg, Hôpital Civil: A. Jaeger.

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Osman, D., Monnet, X., Castelain, V. et al. Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome. Intensive Care Med 35, 69–76 (2009). https://doi.org/10.1007/s00134-008-1307-1

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