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

Area of Science:

• Critical Care Medicine
• Cardiology
• Mechanical Ventilation

Background:

• Lung-protective ventilation (LPV) with low tidal volume (TV) and plateau pressure (Pplat) improves mortality.
• Right ventricular (RV) failure management with invasive mechanical ventilation (IMV) lacks extensive data.
• ACC guidelines recommend LPV and low positive end-expiratory pressure (PEEP) for RV failure.

Purpose of the Study:

• To describe IMV patterns in cardiac ICU patients with RV dysfunction.
• To compare IMV practices against ACC Critical Care Working Group recommendations.
• To evaluate the impact of LPV on two-year survival in this population.

Main Methods:

• Retrospective, single-center study of intubated cardiac ICU patients with RV dysfunction (2017-2022).
• Included patients with RV dysfunction confirmed by echocardiography and requiring fraction of inspired oxygen ≥50%.
• Collected data on median PEEP in the initial 24 hours and subsequent measurements during IMV or 28 days.

Main Results:

• 77.6% of patients (2014/2594) met LPV criteria (TV <8ml/kg, Pplat <30cmH2O).
• LPV was significantly associated with decreased two-year mortality (HR 0.2, p < 0.001).
• Only 42.4% (59/139) received starting PEEP ≤5cmH2O, which showed no association with survival.

Conclusions:

• Most RV dysfunction patients received LPV, aligning with guidelines, but few had low starting PEEP.
• LPV demonstrated a significant survival benefit at two years.
• Low starting PEEP did not show a significant positive or negative association with two-year survival.