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01.01.2009 | Original

Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome

verfasst von: David Osman, Xavier Monnet, Vincent Castelain, Nadia Anguel, Josiane Warszawski, Jean-Louis Teboul, Christian Richard, for the French Pulmonary Artery Catheter Study Group

Erschienen in: Intensive Care Medicine | Ausgabe 1/2009

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Abstract

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.

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Titel: Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome
verfasst von: David Osman
Xavier Monnet
Vincent Castelain
Nadia Anguel
Josiane Warszawski
Jean-Louis Teboul
Christian Richard
for the French Pulmonary Artery Catheter Study Group
Publikationsdatum: 01.01.2009
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 1/2009
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1307-1

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Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome