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

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• 作者：Florence Boissier (1) (2) (3)
  Sandrine Katsahian (4)
  Keyvan Razazi (1)
  Arnaud W. Thille (1) (5)
  Ferran Roche-Campo (1) (6)
  Rusel Leon (1) (7)
  Emmanuel Vivier (1) (8)
  Laurent Brochard (1) (9)
  Antoine Vieillard-Baron (10)
  Christian Brun-Buisson (1) (2) (3)
  Armand Mekontso Dessap (1) (11) (2) (3)
  
• 关键词：Acute lung injury ; Right ventricle ; Mechanical ventilation ; Echocardiography
• 刊名：Intensive Care Medicine
• 出版年：2013
• 出版时间：October 2013
• 年：2013
• 卷：39
• 期：10
• 页码：1725-1733
• 全文大小：308KB
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• 作者单位：Florence Boissier (1) (2) (3)
  Sandrine Katsahian (4)
  Keyvan Razazi (1)
  Arnaud W. Thille (1) (5)
  Ferran Roche-Campo (1) (6)
  Rusel Leon (1) (7)
  Emmanuel Vivier (1) (8)
  Laurent Brochard (1) (9)
  Antoine Vieillard-Baron (10)
  Christian Brun-Buisson (1) (2) (3)
  Armand Mekontso Dessap (1) (11) (2) (3)
  
  1. AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Créteil, 94010, France
  2. INSERM, Unité U955 (IMRB), Créteil, 94010, France
  3. Faculté de Médecine, Université Paris Est Créteil Val de Marne, Créteil, 94010, France
  4. Clinical Research Unit, AP-HP, Groupe Henri Mondor-Albert Chenevier, 94010, Créteil, France
  5. Medical Intensive Care Unit, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
  6. Hospital de Sant Pau, Servei de Medicina Intensiva, Barcelona, Spain
  7. Centre Hospitalier Intercommunal de Créteil, Réanimation Polyvalente, 94010, Créteil, France
  8. Centre Hospitalier Saint Joseph, Réanimation Polyvalente, Lyon, 69001, France
  9. Intensive Care Division, University Hospital, Geneva, Switzerland
  10. AP-HP, H?pital Ambroise Paré, Service de Réanimation, Boulogne-Billancourt, 92100, France
  11. Service de Réanimation Médicale, CHU Henri Mondor, 51 Av Mal de Lattre de Tassigny, 94010, Créteil Cedex, France
  

文摘

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, 16-7?%). 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.