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Intensive Care Medicine

, Volume 39, Issue 10, pp 1734–1742 | Cite as

Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: a multicenter study

  • Gwenaëlle Lhéritier
  • Annick Legras
  • Agnès Caille
  • Thierry Lherm
  • Armelle Mathonnet
  • Jean-Pierre Frat
  • Anne Courte
  • Laurent Martin-Lefèvre
  • Jean-Paul Gouëllo
  • Jean-Bernard Amiel
  • Denis Garot
  • Philippe VignonEmail author
Original

Abstract

Purpose

We sought to determine the prevalence of and factors associated with acute cor pulmonale (ACP) and patent foramen ovale (PFO) at the early phase of acute respiratory distress syndrome (ARDS), and to assess their relation with mortality.

Methods

In this prospective multicenter study, 200 patients submitted to protective ventilation for early moderate to severe ARDS [PaO2/FIO2: 115 ± 39 with FIO2: 1; positive end-expiratory pressure (PEEP): 10.6 ± 3.1 cmH2O] underwent transthoracic (TTE) and transesophageal echocardiography (TEE) <48 h after admission. Echocardiograms were independently interpreted by two experts. Factors associated with ACP, PFO, and 28-day mortality were identified using multivariate regression analysis.

Results

TEE depicted ACP in 45/200 patients [22.5%; 95 % confidence interval (CI) 16.9–28.9 %], PFO in 31 patients (15.5 %; 95 % CI 10.8–21.3 %), and both ACP and PFO in 9 patients (4.5 %; 95 % CI 2.1–8.4 %). PFO shunting was small and intermittent in 27 patients, moderate and consistent in 4 patients, and large or extensive in no instances. PaCO2 >60 mmHg was strongly associated with ACP [odds ratio (OR) 3.70; 95 % CI 1.32–10.38; p = 0.01]. No factor was independently associated with PFO, with only a trend for age (OR 2.07; 95 % CI 0.91–4.72; p = 0.08). Twenty-eight-day mortality was 23 %. Plateau pressure (OR 1.15; 95 % CI 1.05–1.26; p < 0.01) and air leaks (OR 5.48; 95 % CI 1.30–22.99; p = 0.02), but neither ACP nor PFO, were independently associated with outcome.

Conclusions

TEE screening allowed identification of ACP in one-fourth of patients submitted to protective ventilation for early moderate to severe ARDS. PFO shunting was less frequent and never large or extensive. ACP and PFO were not related to outcome.

Keywords

ARDS Acute cor pulmonale Patent foramen ovale Interatrial shunt Echocardiography 

Notes

Acknowledgments

We gratefully thank Isabelle Herafa and Paul Bourzeix for their invaluable help in the study. We are also indebted to Dr. Yves Roudaut and Dr. Vincent Hummel for their independent interpretation of chest radiographs. This work was supported by a bourse de recherche clinique de la Société de Réanimation de Langue Française (2008).

Conflicts of interest

The authors declare that they have no conflict of interest.

Supplementary material

134_2013_3017_MOESM1_ESM.mp4 (482 kb)
Supplementary material 1 (MP4 482 kb) Loop 1. Transesophageal echocardiography in a ventilated patient with ARDS: four-chamber view of the heart disclosing an enlarged right ventricle
134_2013_3017_MOESM2_ESM.mp4 (476 kb)
Supplementary material 2 (MP4 476 kb) Loop 2. Transesophageal echocardiography in a ventilated patient with ARDS: short-axis view of the heart disclosing an enlarged right ventricle associated with paradoxical septal motion. These two findings are consistent with acute cor pulmonale

Supplementary material 3 (MP4 745 kb) Loop 3. Transesophageal echocardiography in a ventilated patient with ARDS: bicaval view disclosing a patent foramen ovale during a contrast study. Note that microcavitations fully opacified the right atrium and rapidly entered the left atrium through the foramen ovale

134_2013_3017_MOESM4_ESM.avi (72.5 mb)
Supplementary material 4 (AVI 74254 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • Gwenaëlle Lhéritier
    • 1
  • Annick Legras
    • 2
    • 3
  • Agnès Caille
    • 4
    • 5
    • 6
  • Thierry Lherm
    • 7
  • Armelle Mathonnet
    • 8
  • Jean-Pierre Frat
    • 9
  • Anne Courte
    • 10
  • Laurent Martin-Lefèvre
    • 11
  • Jean-Paul Gouëllo
    • 12
  • Jean-Bernard Amiel
    • 1
  • Denis Garot
    • 2
    • 3
  • Philippe Vignon
    • 1
    • 13
    • 14
    • 15
    Email author
  1. 1.CHU LimogesRéanimation PolyvalenteLimogesFrance
  2. 2.CHU ToursRéanimation MédicaleToursFrance
  3. 3.INSERM CIC-ITToursFrance
  4. 4.INSERM CIC 202ToursFrance
  5. 5.Université François RabelaisToursFrance
  6. 6.CHU ToursToursFrance
  7. 7.CH ChartresRéanimation MédicaleChartresFrance
  8. 8.CHR OrléansRéanimation Médicale PolyvalenteOrléansFrance
  9. 9.CHU PoitiersRéanimation MédicalePoitiersFrance
  10. 10.CH Saint-BrieucRéanimation PolyvalenteSaint-BrieucFrance
  11. 11.CH La Roche-sur-YonRéanimation MédicaleLa Roche-sur-YonFrance
  12. 12.CH Saint-MaloRéanimation PolyvalenteSaint-MaloFrance
  13. 13.INSERM, CIC-P 0801LimogesFrance
  14. 14.Université de LimogesLimogesFrance
  15. 15.CHU DupuytrenRéanimation PolyvalenteLimoges CedexFrance

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