Mechanical ventilation patterns and outcomes in patients with right ventricular (RV) dysfunction: A cohort study

Lung-protective ventilation (LPV), defined as tidal volume (TV) <8ml/kg ideal body weight and plateau pressure (Pplat) <30cmH2O, improves mortality in many populations. Although little data exists for IMV management of patients with RV failure, the American College of Cardiology (ACC) Critical Care Working Group recommends LPV and low (<3-5cmH2O) starting positive end-expiratory pressure (PEEP) in right ventricular (RV) failure.

Describe IMV patterns in cardiac ICU patients with RV dysfunction and compare to ACC Critical Care Working Group recommendations. Secondary was to evaluate LPV impact on two-year survival.

This is a single-center, retrospective study. We included patients intubated >24 h in the cardiac ICU between 2017-2022 with RV dysfunction prior to intubation, identified by echocardiography. Patients were excluded if they did not have at least one fraction of inspired oxygen ≥50 %. We collected median PEEP in initial 24 h and twice daily measurements (6am/6pm) for IMV duration or 28 days.

There were 192 patients, with 4010 TVs and 2628 Pplats. When both TV and Pplat were available (2594), 2014/2594 (77.6 %) qualified as LPV. LPV was associated with decreased two-year mortality (HR 0.2, p < 0.001). Less than half (59/139, 42.4 %) had starting PEEP of ≤5cmH2O, which was not associated with two-year survival.

As compared to ACC Critical Care Working group guidelines, most patients with RV dysfunction at our institution were ventilated using LPV but not low starting PEEP. LPV was associated with increased two-year survival and low starting PEEP was not associated in a positive or negative way.