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

Abstract

To analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS). 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). 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, 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. 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.