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01-10-2013 | Original

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

Authors: 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 Vignon

Published in: Intensive Care Medicine | Issue 10/2013

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/F_IO₂: 115 ± 39 with F_IO₂: 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.

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Title: Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: a multicenter study
Authors: 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 Vignon
Publication date: 01-10-2013
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 10/2013
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3017-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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