Volume 17 Supplement 2

33rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Right ventricular restriction in interventional lung assist for acute respiratory distress syndrome

  • G Tavazzi1,
  • M Bojan2,
  • S Canestrini2,
  • M White2 and
  • S Price2
Critical Care201317(Suppl 2):P171

DOI: 10.1186/cc12109

Published: 19 March 2013

Introduction

Acute cor pulmonale (ACP) is associated with increased mortality in patients ventilated for acute respiratory distress syndrome (ARDS). Interventional lung assist (iLA) allows a lung-protective ventilatory strategy, whilst allowing CO2 removal, but requires adequate right ventricular (RV) function. RV restriction (including presystolic pulmonary A wave) [1] is not routinely assessed in ARDS.

Methods

A prospective analysis of retrospectively collected data in patients with echo during iLA was performed. Data included epidemiologic and ventilatory factors, LV/RV function, evidence of RV restriction and pulmonary hemodynamics. Data are shown as mean ± SD/median (interquartile range).

Results

Thirty-two patients (45 ± 17 years), 22 male (68%), SOFA score 11.15 ± 2.38 were included. Pulmonary hypertension (PHT) was 53%, and hospital mortality 43%. Mortality was not associated with age, days on iLA, length of ICU stay, inotropic support, nitric oxide or level of ventilatory support, but was associated with pressor requirement (P = 0.005), a worse PaO2:FiO2 ratio (9.4 (7.8 to 12.6) vs. 15.2 (10.7 to 23.9), P = 0.009) and higher pulmonary artery pressures (56.5 mmHg (50 to 60) vs. 44.5 (40.5 to 51.2), P = 0.02). No echo features of ACP were found, with no significant difference between RV systolic function, pulmonary acceleration time and pulmonary velocity time integral between survivors and nonsurvivors. The incidence of RV restriction was high (43%), and independent of PHT, RV systolic function and level of respiratory support, but correlated with CO2 levels (restrictive 7.1 kPa (7.4 to 8.0) vs. 6.1 (5.8 to 6.8), P = 0.03). See Figure 1.
https://static-content.springer.com/image/art%3A10.1186%2Fcc12109/MediaObjects/13054_2013_Article_1266_Fig1_HTML.jpg
Figure 1

(abstract P171)

Conclusion

Typical echo features of ACP were not seen in this study, possibly because of the protective ventilatory strategies allowed by use of iLA. The incidence of RV restriction may reflect more subtle abnormalities of RV function. Further studies are required to elucidate RV pathophysiology in critically ill adult patients with ARDS.

Authors’ Affiliations

(1)
University of Pavia Foundation Policlinico San Matteo IRCCS
(2)
Royal Brompton Hospital

References

  1. Cullen S, et al.: Circulation. 1995, 91: 1782-1789. 10.1161/01.CIR.91.6.1782View ArticlePubMedGoogle Scholar

Copyright

© Tavazzi et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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