Intensive Care Medicine

, Volume 42, Issue 5, pp 862–870 | Cite as

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

  • Armand Mekontso DessapEmail author
  • Florence Boissier
  • Cyril Charron
  • Emmanuelle Bégot
  • Xavier Repessé
  • Annick Legras
  • Christian Brun-Buisson
  • Philippe Vignon
  • Antoine Vieillard-Baron
Seven-Day Profile Publication



Increased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP).


To determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP.


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 H2O, arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) 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, PaO2/FiO2 ratio, respiratory rate, and driving pressure, while prone position was protective.


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.


ARDS Right ventricle Mechanical ventilation Echocardiography 



This study was funded by the nonprofit public organization Assistance Publique-Hôpitaux de Paris and a grant of the Société de Réanimation de Langue Française. We thank Dr. Florence Canoui-Poitrine for her statistical advices.

Compliance with ethical standards


The study was funded in part by a grant of the French Intensive Care Society (Société de Réanimation de Langue Française).

Conflicts of interest

The authors declare that they have no conficts of interest.

Supplementary material

134_2015_4141_MOESM1_ESM.doc (56 kb)
Supplementary material 1 (DOC 56 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Armand Mekontso Dessap
    • 1
    • 2
    Email author
  • Florence Boissier
    • 1
    • 2
  • Cyril Charron
    • 3
  • Emmanuelle Bégot
    • 4
    • 5
    • 6
  • Xavier Repessé
    • 3
  • Annick Legras
    • 7
  • Christian Brun-Buisson
    • 1
    • 2
  • Philippe Vignon
    • 7
  • Antoine Vieillard-Baron
    • 3
    • 8
    • 9
  1. 1.Service de Réanimation Médicale, DHU ATVB, Hôpitaux Universitaire Henri MondorAssistance Publique–Hôpitaux de ParisCréteil CedexFrance
  2. 2.Groupe de Recherche Clinique CARMAS, Institut Mondor de Recherche Biomédicale, Faculté de Médecine de CréteilUniversité Paris Est Créteil Val de MarneCréteilFrance
  3. 3.Service de Réanimation, Pôle Thorax-Maladies Cardiovasculaires-Abdomen-Métabolisme, Hôpital Ambroise ParéAssistance Publique - Hôpitaux de ParisBoulogne-BillancourtFrance
  4. 4.Réanimation polyvalente, Hôpital DupuytrenCentre hospitalier et universitaire de LimogesLimogesFrance
  5. 5.Centre d’Investigation Clinique – INSERM 1435, Hôpital DupuytrenCHU LimogesLimogesFrance
  6. 6.University of LimogesLimogesFrance
  7. 7.Réanimation médicale CHU de ToursToursFrance
  8. 8.Faculté de MedicineUniversité de Versailles Saint-Quentin en YvelinesSaint-Quentin en YvelinesFrance
  9. 9.Equipe 5 (EpReC, Epidémiologie Rénale et Cardiovasculaire)Centre de recherche en épidémiologie et santé des populations – INSERM U-1018VillejuifFrance

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