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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2013

01-10-2013 | Original

Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome

Authors: Florence Boissier, Sandrine Katsahian, Keyvan Razazi, Arnaud W. Thille, Ferran Roche-Campo, Rusel Leon, Emmanuel Vivier, Laurent Brochard, Antoine Vieillard-Baron, Christian Brun-Buisson, Armand Mekontso Dessap

Published in: Intensive Care Medicine | Issue 10/2013

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Abstract

Purpose

Pulmonary vascular dysfunction is common during acute respiratory distress syndrome (ARDS), but there is controversy concerning prevalence and prognosis of cor pulmonale during protective ventilation for ARDS.

Methods

This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and twenty-six consecutive patients with moderate to severe ARDS (Berlin definition) ventilated with plateau pressure limited at 30 cmH2O (mean PEEP of 8.8 ± 3.6 cmH2O) underwent transesophageal echocardiography (TEE) within the first 3 days after the diagnosis of ARDS. Cor pulmonale was defined as a dilated right ventricle associated with septal dyskinesia.

Results

Cor pulmonale was detected in 49 patients (prevalence of 22 %; 95 % confidence interval, 16–27 %). Multivariate logistic regression identified infectious causes of lung injury and higher driving pressures as independent factors associated with cor pulmonale. Patients with cor pulmonale exhibited a higher incidence of shock (need for vasoactive drug) at the time of TEE and were more often managed with prone positioning and/or nitric oxide as adjunctive therapy for severe hypoxemia during ARDS course. The 28-day mortality rate was significantly higher in the group with cor pulmonale (60 vs. 36 %, p < 0.01). Multivariate logistic regression identified McCabe and Jackson class, lung injury not related to pneumonia, aspiration, or sepsis, lactic acidosis, driving pressure, and cor pulmonale as independent risk factors for 28-day mortality.

Conclusion

Cor pulmonale occurrence is not negligible in ARDS patients ventilated with airway pressure limitation. Cor pulmonale was associated with sepsis and higher values of driving pressure and was an independent risk factor for 28-day mortality in our series.
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Metadata
Title
Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome
Authors
Florence Boissier
Sandrine Katsahian
Keyvan Razazi
Arnaud W. Thille
Ferran Roche-Campo
Rusel Leon
Emmanuel Vivier
Laurent Brochard
Antoine Vieillard-Baron
Christian Brun-Buisson
Armand Mekontso Dessap
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/s00134-013-2941-9

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