Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact

Abstract

We report a 22 % prevalence of ACP and a poor outcome of severe ACP. We propose a simple clinical risk score for early identification of ACP that could trigger specific therapeutic strategies to reduce RV afterload.

Executive summary on the use of ultrasound in the critically ill: consensus report from the 3rd Course on Acute Care Ultrasound (CACU)

“…In case of clinical suspicion of pulmonary embolism, in a patient who had a cardiac arrest following by circulatory failure, it may provide a diagnosis in a few minutes at the bedside by visualizing a clot in the pulmonary arteries [43]. In severe ARDS patients, this is the gold standard approach in order to diagnose ACP [44] and open formaen ovale which occurs in 20-22% of patients [45]. …”

“Low-” versus “high”-frequency oscillation and right ventricular function in ARDS. A randomized crossover study

“…These results might be partly attributable to right ventricular (RV) overload, dysfunction, and failure caused by concurrent high intrathoracic pressures and hypercapnia, and consequent hemodynamic instability and increased need for inotropic/vasopressor support [9–12]. Indeed, mortality rate is increased in ARDS patients with acute cor pulmonale [13]. …”

Acute cor pulmonale and the acute respiratory distress syndrome

“…However, these strategies for treating ACP have not yet been tested prospectively. In summary, the study by Mekontso-Dessap et al [7] provides new information on the incidence of ACP (22 %) in moderate to severe ARDS in the era of lung protective ventilation. These authors report a significant association of severe ACP with higher mortality and propose a four-point clinical score that may have value for assessing the benefit (or not) of TEE to diagnose ACP in ARDS patients.…”

“…If the increase in afterload is substantial, impairment of RV systolic function and interventricular septal kinetics results in a reduction in cardiac output and acute core pulmonale (ACP) with RV failure and shock. Before the era of lung protective ventilation, the incidence of ACP from elevated PVR in ARDS was as high as 60 % [6].In a recent article in Intensive Care Medicine, Mekontso-Dessap and colleagues [7] report the results of a study of 752 moderate to severe ARDS patients (ratio of partial pressure arterial oxygen and fraction of inspired oxygen: PaO 2 /FiO 2 \200 mmHg) designed (1) to determine the incidence of ACP, (2) to test a clinical score to predict the presence of ACP and (3) to determine the association of ACP with mortality. The diagnosis of ACP was determined by transesophageal echocardiography (TEE) and defined by septal dyskinesia with a dilated RV, end-diastolic RV/left ventricle area ratio of [0.6, and a score of [1 for severe ACP.…”

“…In a recent article in Intensive Care Medicine, Mekontso-Dessap and colleagues [7] report the results of a study of 752 moderate to severe ARDS patients (ratio of partial pressure arterial oxygen and fraction of inspired oxygen: PaO 2 /FiO 2 \200 mmHg) designed (1) to determine the incidence of ACP, (2) to test a clinical score to predict the presence of ACP and (3) to determine the association of ACP with mortality. The diagnosis of ACP was determined by transesophageal echocardiography (TEE) and defined by septal dyskinesia with a dilated RV, end-diastolic RV/left ventricle area ratio of [0.6, and a score of [1 for severe ACP.…”