The monitoring of acute cor pulmonale is still necessary in "Berlin" ARDS patients

Excerpt

ARDS in the new Berlin classification has been defined as a heterogeneous syndrome with impairment of oxygenation not fully explained by cardiac failure or fluid overload with bilateral opacities at chest imaging not fully explained by effusions, lobar/lung collapse, or nodules [1]. From an anatomical point of view the lung in ARDS is characterized by the presence of both alveolar and pulmonary capillary injures which increase the pulmonary arterial pressure [2, 3]. The pulmonary vasculature is a low resistance, high capacitance system, which allows a high increase in blood flow without significant changes in pulmonary artery pressure. The mean determinants of pulmonary artery pressure are the cardiac output, the venous pressure, and the vascular lung area [4]. The pulmonary hypertension promotes right ventricular dilatation/dysfunction, an increase in tricuspid regurgitation, liver and kidney congestion, and owing to interventricular dependency, a left ventricular dysfunction with reduction in blood pressure, cardiac output, and multiple organ failure [4]. …