Titre | Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome |
Type de publication | Article de revue |
Auteur | Osman, David, Monnet, Xavier, Castelain, Vincent, Anguel, Nadia, Warszawski, Josiane, Teboul, Jean-Louis, Richard, Christian, French Pulmonary Artery Catheter Study Group, |
Editeur | Springer Verlag |
Type | Article scientifique dans une revue à comité de lecture |
Année | 2009 |
Langue | Anglais |
Date | 2009/01/01 |
Numéro | 1 |
Pagination | 69 - 76 |
Volume | 35 |
Titre de la revue | Intensive Care Medicine |
ISSN | 0342-4642 / 1432-1238 |
Mots-clés | Acute cor pulmonale, Acute respiratory distress syndrome, Anesthesiology, Circulatory failure, Emergency Medicine, Intensive / Critical Care Medicine, Pain Medicine, Pediatrics, Pneumology/Respiratory System, Pulmonary hypertension, Right ventricular dysfunction |
Résumé en anglais | 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. |
URL de la notice | http://okina.univ-angers.fr/publications/ua3572 |
DOI | 10.1007/s00134-008-1307-1 |
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