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Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS
Published on: November 26, 2018
Acute respiratory distress syndrome, mechanical ventilation, and right ventricular function
Koceila Bouferrache1, Antoine Vieillard-Baron
1Intensive Care Unit, University Hospital Ambroise Paré, Faculté de Médecine Paris Ile de France Ouest, Université de Versailles Saint Quentin en Yvelines, Boulogne, France.
Current Opinion in Critical Care
|December 16, 2010
Summary
Positive pressure ventilation can impact right ventricular function in acute respiratory distress syndrome (ARDS). An RV protective approach, including prone positioning, is crucial for managing acute cor pulmonale (ACP) and improving patient outcomes.
Area of Science:
- Critical Care Medicine
- Pulmonology
- Cardiology
Background:
- Positive pressure ventilation is a cornerstone in managing acute respiratory distress syndrome (ARDS).
- Right ventricular (RV) dysfunction, or acute cor pulmonale (ACP), is a significant concern in ARDS patients.
- Understanding the interplay between ventilation strategies and RV function is critical for optimizing patient care.
Purpose of the Study:
- To review the impact of positive pressure ventilation on RV function in ARDS.
- To identify conditions where ACP may worsen prognosis.
- To define an "RV protective approach" for mechanical ventilation in ARDS.
Main Methods:
- Review of existing literature on positive pressure ventilation and RV function in ARDS.
- Analysis of factors contributing to ACP and its prognostic implications.
- Synthesis of evidence to propose an RV protective ventilation strategy.
Main Results:
- Acute cor pulmonale (ACP) occurs in approximately 25% of unselected ARDS patients.
- ACP is associated with adverse outcomes, including patent foramen ovale shunting and reduced ventilator-free days.
- Optimizing ventilation involves maintaining plateau pressure below 27-28 cmH2O, controlling hypercapnia, avoiding intrinsic PEEP, and applying low PEEP.
- Recent findings suggest a potential inverse relationship between PEEP's detrimental effect on RV function and its lung recruitment capacity.
Conclusions:
- Routine assessment of RV function guides an "RV protective approach" to mechanical ventilation in ARDS.
- This protective strategy aims to mitigate the negative effects of ventilation on the right ventricle.
- Adjunctive therapies, such as prone positioning, can further enhance RV function and are recommended alongside the RV protective approach.
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