• Intensive care medicine · Jan 2009

    Randomized Controlled Trial

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

    • David Osman, Xavier Monnet, Vincent Castelain, Nadia Anguel, Josiane Warszawski, Jean-Louis Teboul, Christian Richard, and French Pulmonary Artery Catheter Study Group.
    • Service de Réanimation Médicale, Hôpital de Bicêtre, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-11 Sud, Le Kremlin-Bicêtre, France.
    • Intensive Care Med. 2009 Jan 1;35(1):69-76.

    ObjectiveTo analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS).Patients And MethodsA 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).ResultsRight 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, PaO(2)/FiO(2) and PaCO(2) 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 cmH(2)O, NS). In multivariate analysis, PaO(2)/FiO(2), mean arterial pressure, arterial pH, SvO(2), MPAP and presence of CVP > PAOP, but not RVF, were independently associated with day-90 mortality.ConclusionIn 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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