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

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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, 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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https://hal.univ-angers.fr/hal-03268773
Contributeur : Okina Université d'Angers <>
Soumis le : mercredi 23 juin 2021 - 14:25:22
Dernière modification le : vendredi 25 juin 2021 - 03:24:54

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David Osman, Xavier Monnet, Vincent Castelain, Nadia Anguel, Josiane Warszawski, et al.. Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome. Intensive Care Medicine, Springer Verlag, 2009, 35 (1), pp.69 - 76. ⟨10.1007/s00134-008-1307-1⟩. ⟨hal-03268773⟩

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