Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome
Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome
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DOI：
10.1007/s00134-008-1307-1
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发表时间：
2009-01-01
影响因子：
38.9
通讯作者：
Richard, Christian
中科院分区：
文献类型：
--
作者：
Osman, David;Monnet, Xavier;Richard, Christian
为分析急性呼吸窘迫综合征（ARDS）患者右心室衰竭（RVF）的发生率及其对预后的影响，将145例已纳入法国肺动脉导管（PAC）研究的ARDS患者随机分配接受PAC治疗。所有患者均根据旨在限制平台压的策略进行通气。RVF的定义是：（1）平均肺动脉压（MPAP）> 25 mmHg，（2）中心静脉压（CVP）高于肺动脉闭塞压（PAOP），（3）每搏输出量指数< 30 mL m（-2）。第90天的死亡率为68%，患有裂谷热（裂谷热+）和没有裂谷热的患者之间没有差异（分别为71%和67%）。两组SAPS II、PaO 2/FiO（2）、PaCO 2相似。RVF+组的潮气量和I/E比显著较高（9.7 +/- A 2.8 vs. 8.6 +/- A 1.8 ml m（-2）和0.7 +/- A 0.5 vs. 0.5 +/- A 0.2）。RVF+组的平台压往往较高（28 +/- A 6 vs. 25 +/- A 6 cmH（2）O，NS）。在多变量分析中，PaO 2/FiO（2）、平均动脉压、动脉pH、SvO（2）、MPAP和CVP > PAOP与90天死亡率独立相关，而不是RVF。在这组患者中，在ARDS早期进行研究，并根据旨在限制平台压的策略进行通气，RVF的存在约为10%。与MPAP和CVP > PAOP的存在不同，RVF在这一早期阶段似乎不是死亡率的独立因素。
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, PaO2/FiO(2) and PaCO2 were similar in both groups. Tidal volume and I/E ratio were significantly higher in RVF+ (9.7 +/- A 2.8 vs. 8.6 +/- A 1.8 ml m(-2) and 0.7 +/- A 0.5 vs. 0.5 +/- A 0.2). Plateau pressure tended to be higher in RVF+ (28 +/- A 6 vs. 25 +/- A 6 cmH(2)O, NS). In multivariate analysis, PaO2/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.