Intensive Care Medicine

, Volume 39, Issue 10, pp 1725–1733 | Cite as

Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome

  • Florence Boissier
  • Sandrine Katsahian
  • Keyvan Razazi
  • Arnaud W. Thille
  • Ferran Roche-Campo
  • Rusel Leon
  • Emmanuel Vivier
  • Laurent Brochard
  • Antoine Vieillard-Baron
  • Christian Brun-Buisson
  • Armand Mekontso Dessap
Original

Abstract

Purpose

Pulmonary vascular dysfunction is common during acute respiratory distress syndrome (ARDS), but there is controversy concerning prevalence and prognosis of cor pulmonale during protective ventilation for ARDS.

Methods

This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and twenty-six consecutive patients with moderate to severe ARDS (Berlin definition) ventilated with plateau pressure limited at 30 cmH2O (mean PEEP of 8.8 ± 3.6 cmH2O) underwent transesophageal echocardiography (TEE) within the first 3 days after the diagnosis of ARDS. Cor pulmonale was defined as a dilated right ventricle associated with septal dyskinesia.

Results

Cor pulmonale was detected in 49 patients (prevalence of 22 %; 95 % confidence interval, 16–27 %). Multivariate logistic regression identified infectious causes of lung injury and higher driving pressures as independent factors associated with cor pulmonale. Patients with cor pulmonale exhibited a higher incidence of shock (need for vasoactive drug) at the time of TEE and were more often managed with prone positioning and/or nitric oxide as adjunctive therapy for severe hypoxemia during ARDS course. The 28-day mortality rate was significantly higher in the group with cor pulmonale (60 vs. 36 %, p < 0.01). Multivariate logistic regression identified McCabe and Jackson class, lung injury not related to pneumonia, aspiration, or sepsis, lactic acidosis, driving pressure, and cor pulmonale as independent risk factors for 28-day mortality.

Conclusion

Cor pulmonale occurrence is not negligible in ARDS patients ventilated with airway pressure limitation. Cor pulmonale was associated with sepsis and higher values of driving pressure and was an independent risk factor for 28-day mortality in our series.

Keywords

Acute lung injury Right ventricle Mechanical ventilation Echocardiography 

Supplementary material

134_2013_2941_MOESM1_ESM.doc (54 kb)
Supplementary material 1 (DOC 54 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Florence Boissier
    • 1
    • 2
    • 3
  • Sandrine Katsahian
    • 4
  • Keyvan Razazi
    • 1
  • Arnaud W. Thille
    • 1
    • 5
  • Ferran Roche-Campo
    • 1
    • 6
  • Rusel Leon
    • 1
    • 7
  • Emmanuel Vivier
    • 1
    • 8
  • Laurent Brochard
    • 1
    • 9
  • Antoine Vieillard-Baron
    • 10
  • Christian Brun-Buisson
    • 1
    • 2
    • 3
  • Armand Mekontso Dessap
    • 1
    • 2
    • 3
    • 11
  1. 1.AP-HP, Groupe Henri Mondor-Albert ChenevierService de Réanimation MédicaleCréteilFrance
  2. 2.INSERM, Unité U955 (IMRB)CréteilFrance
  3. 3.Faculté de MédecineUniversité Paris Est Créteil Val de MarneCréteilFrance
  4. 4.Clinical Research UnitAP-HP, Groupe Henri Mondor-Albert ChenevierCréteilFrance
  5. 5.Medical Intensive Care UnitCentre Hospitalo-Universitaire de PoitiersPoitiersFrance
  6. 6.Hospital de Sant Pau, Servei de Medicina IntensivaBarcelonaSpain
  7. 7.Centre Hospitalier Intercommunal de Créteil, Réanimation PolyvalenteCréteilFrance
  8. 8.Centre Hospitalier Saint Joseph, Réanimation PolyvalenteLyonFrance
  9. 9.Intensive Care DivisionUniversity HospitalGenevaSwitzerland
  10. 10.AP-HP, Hôpital Ambroise Paré, Service de RéanimationBoulogne-BillancourtFrance
  11. 11.Service de Réanimation Médicale, CHU Henri MondorCréteil CedexFrance

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