Right heart function during acute respiratory distress syndrome

Area of Science:

• Critical Care Medicine
• Cardiology
• Pulmonology

Background:

• Acute respiratory distress syndrome (ARDS) is associated with high mortality, often linked to circulatory failure.
• Right ventricular (RV) dysfunction, termed acute cor pulmonale (ACP), is a primary driver of mortality in ARDS.
• Identifying and mitigating ARDS complications is crucial for improving patient outcomes.

Purpose of the Study:

• To highlight the association between specific ventilator parameters and RV failure in ARDS.
• To emphasize the importance of RV protection strategies in ARDS management.
• To outline key interventions for preventing and monitoring acute cor pulmonale.

Main Methods:

• Review of recent findings on factors associated with acute cor pulmonale in ARDS.
• Focus on ventilator strategies aimed at RV protection.
• Emphasis on prone positioning (PP) and echocardiographic monitoring of the RV.

Main Results:

• Driving pressure ≥18 cmH2O, PaCO2 ≥48 mmHg, and PaO2/FiO2 <150 mmHg are identified as preventable factors linked to ACP.
• Early and extended prone positioning (PP) is a key strategy for RV protection.
• Daily RV monitoring via echocardiography is essential for managing ACP.

Conclusions:

• Ventilator strategies must prioritize RV protection in ARDS patients.
• Implementing PP and regular RV assessment can mitigate mortality associated with ACP.
• Addressing preventable factors is critical for improving hemodynamic stability in ARDS.