Is right ventricular function the one that matters in ARDS patients? Definitely yes

  • Antoine Vieillard-Baron

Abstract

Since the beginning of the 1980s, intensivists have known that acute respiratory distress syndrome (ARDS) is strongly associated with pulmonary hypertension and right ventricular (RV) dysfunction [1, 2]. Three phenomena promote this. First, lung damage per se, which combines alveolar injury with capillary destruction and obstruction by clots. Second, remodeling of the pulmonary circulation, defined as a muscularization of normally nonmuscularized vessels, mediated by hypoxemia and hypercarbia, and finally, positive pressure ventilation, which increases the distending pressure of the lung and thus crushes the pulmonary capillaries. These phenomena are reversible, except for pulmonary capillary destruction, which was especially observed when tidal volume was adjusted to correct the PaCO2, and so the plateau pressure (Pplateau) is not limited. During this period, RV failure was frequent and associated with high mortality [24]. In particular, Jardin et al. found in a series of 23 patients an incidence of acute cor pulmonale (ACP) as high as 61% with 100% mortality in the most severe forms [2]. ACP is considered to reflect RV dysfunction due to an acute increase in RV afterload, as in ARDS. Its definition is echocardiographic: RV dilatation in combination with paradoxical septal motion during systole.

Keywords

Right Ventricular Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome Patient Right Ventricular Function Right Ventricular Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Zapol W, Snider M (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480PubMedCrossRefGoogle Scholar
  2. 2.
    Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP (1985) Two-dimensional echocardiography evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 13:952–956PubMedCrossRefGoogle Scholar
  3. 3.
    Squara P, Dhainaut JF, Artigas A, Carlet J (1998) Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS study. Intensive Care Med 24:1018–1028PubMedCrossRefGoogle Scholar
  4. 4.
    Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F (1998) Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 158:1076–1081Google Scholar
  5. 5.
    The Acute Respiratory Distress Syndrome Network (2000) Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 342:1301–1308CrossRefGoogle Scholar
  6. 6.
    Scherrer-Crosbie M, Streckenbach SC, Zapol W (2001) Acute cor pulmonale in acute respiratory distress syndrome: a dreaded complication of the past? Crit Care Med 29:1641–1642PubMedCrossRefGoogle Scholar
  7. 7.
    Borges J, Okamoto V, Matos G, Caramez M, Arantes P, Barros F, Souza C, Victorino J, Kacmarek R, Barbas C, Carvalho C, Amato M (2006) Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome. Am J Respir Crit Care Med 174:268–278PubMedCrossRefGoogle Scholar
  8. 8.
    Page B, Vieillard-Baron A, Beauchet A, Aegerter P, Prin S, Jardin F (2003) Low stretch ventilation strategy in acute respiratory distress syndrome: eight years of clinical experience in a single center. Crit Care Med 31:765–769PubMedCrossRefGoogle Scholar
  9. 9.
    Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, Beauchet A, Jardin F (2001) Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis. Crit Care Med 29:1551–1555PubMedCrossRefGoogle Scholar
  10. 10.
    Osman D, Monnet X, Castelain V, Anguel N, Warszawski J, Teboul JL, Richard C; for the French Pulmonary Artery Catheter Study Group (2008) Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome. Intensive Care Med. doi:10.1007/s00134-008-1307-1Google Scholar
  11. 11.
    Richard C, Warszawski J, Anguel N, Deye N, Combes A, Barnoud D, Boulain T, Lefort Y, Fartoukh M, Baud F, Boyer A, Brochard L, Teboul JL (2003) Early use of the pulmonary artery catheter and outcomes in patients with shock and acute respiratory distress syndrome: a randomized controlled trial. JAMA 290:2713–2720PubMedCrossRefGoogle Scholar
  12. 12.
    Vieillard-Baron A, Charron C, Caille V, Belliard G, Page B, Jardin F (2007) Prone positioning unloads the right ventricle in severe ARDS. Chest 132:1440–1446PubMedCrossRefGoogle Scholar
  13. 13.
    Jardin F, Vieillard-Baron A (2007) Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med 33:444–447PubMedCrossRefGoogle Scholar
  14. 14.
    Richard JC, Girault C, Leteurtre S, Leclerc F, for the experts group of the SRLF (2005) Ventilatory management of acute respiratory distress syndrome in adult patients and children (new-born excepted). Société de réanimation de langue franijaise experts recommendations. Réanimation 14:313–322Google Scholar
  15. 15.
    Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F (2002) Echo-Doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 166:1310–1319PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Antoine Vieillard-Baron
    • 1
  1. 1.Intensive Care Unit Assistance Publique des Hôpitaux de ParisUniversity Hospital Ambroise ParéBoulogneFrance

Personalised recommendations