1. Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: a multicenter noninvasive hemodynamic study
- Author
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Annick Legras, Philippe Vignon, Emmanuelle Begot, Agnès Caille, Armelle Mathonnet, Gwenaëlle Lhéritier, Anne Courte, Jean-Pierre Frat, Emmanuelle Mercier, Jean-Paul Gouëllo, T Lherm, Laurent Martin-Lefevre, Service de cardiologie [CHU Limoges], CHU Limoges, Centre d'Investigation Clinique de Limoges (CIC1435), CHU Limoges-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Polyvalente [CHU Limoges], Service de Réanimation (ORLEANS - Réa), Centre Hospitalier Régional d'Orléans (CHRO), Service de Réanimation, Hôpital Jean Bernard, CHU de Poitiers, Poitiers, France, Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon, Réanimation médicale, CHU Bretonneau, Service d'Accompagnement et Soins Palliatifs [CHU Limoges], Service de réanimation médicale, Université de Tours-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Centre d’Investigation Clinique [Tours] CIC 1415 (CIC ), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM), MethodS in Patients-centered outcomes and HEalth ResEarch (SPHERE), Université de Tours-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques, Université de Nantes (UN)-Université de Nantes (UN), Université de Tours (UT)-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Bretonneau-Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Université de Tours (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR des Sciences Pharmaceutiques et Biologiques
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Adult ,Male ,medicine.medical_specialty ,ARDS ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,Hemodynamics ,Foramen Ovale, Patent ,Critical Care and Intensive Care Medicine ,Pulmonary heart disease ,Pulmonary Heart Disease ,Internal medicine ,medicine.artery ,medicine ,Humans ,Prospective Studies ,Foramen ovale (heart) ,Aged ,Mechanical ventilation ,Respiratory Distress Syndrome ,business.industry ,Research ,Middle Aged ,medicine.disease ,Respiration, Artificial ,Intensive Care Units ,medicine.anatomical_structure ,Ventricle ,Echocardiography ,Pulmonary artery ,Patent foramen ovale ,Cardiology ,Female ,business - Abstract
Introduction Acute cor pulmonale (ACP) and patent foramen ovale (PFO) remain common in patients under protective ventilation for acute respiratory distress syndrome (ARDS). We sought to describe the hemodynamic profile associated with either ACP or PFO, or both, during the early course of moderate-to-severe ARDS using echocardiography. Methods In this 32-month prospective multicenter study, 195 patients with moderate-to-severe ARDS were assessed using echocardiography during the first 48 h of admission (age: 56 (SD: 15) years; Simplified Acute Physiology Score: 46 (17); PaO2/FiO2: 115 (39); VT: 6.5 (1.7) mL/kg; PEEP: 11 (3) cmH2O; driving pressure: 15 (5) cmH2O). ACP was defined by the association of right ventricular (RV) dilatation and systolic paradoxical ventricular septal motion. PFO was detected during a contrast study using agitated saline in the transesophageal bicaval view. Results ACP was present in 36 patients, PFO in 21 patients, both PFO and ACP in 8 patients and the 130 remaining patients had neither PFO nor ACP. Patients with ACP exhibited a restricted left ventricle (LV) secondary to RV dilatation and had concomitant RV dysfunction, irrespective of associated PFO, but preserved LV systolic function. Despite elevated systolic pulmonary artery pressure (sPAP), patients with isolated PFO had a normal RV systolic function. sPAP and PaCO2 levels were significantly correlated. Conclusions In patients under protective mechanical ventilation with moderate-to-severe ARDS, ACP was associated with LV restriction and RV failure, whether PFO was present or not. Despite elevated sPAP, PFO shunting was associated with preserved RV systolic function.
- Published
- 2015
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