期刊
INTENSIVE CARE MEDICINE
卷 35, 期 1, 页码 69-76出版社
SPRINGER
DOI: 10.1007/s00134-008-1307-1
关键词
Acute respiratory distress syndrome; Right ventricular dysfunction; Acute cor pulmonale; Pulmonary hypertension; Circulatory failure
To analyse the incidence and the impact on outcome of right ventricular failure (RVF) in patients with acute respiratory distress syndrome (ARDS). A total of 145 ARDS patients included in the previously published French Pulmonary Artery Catheter (PAC) study were randomly assigned to receive a PAC. All patients were ventilated according to a strategy aimed at limiting plateau pressure. The RVF was defined by the concomitant presence of: (1) a mean pulmonary artery pressure (MPAP) > 25 mmHg, (2) a central venous pressure (CVP) higher than pulmonary artery occlusion pressure (PAOP) and (3) a stroke volume index < 30 mL m(-2). Right ventricular failure was present in 9.6% of patients. Mortality was 68% at day-90 with no difference between patients with RVF (RVF+) and without RVF (71 vs. 67%, respectively). SAPS II, PaO2/FiO(2) and PaCO2 were similar in both groups. Tidal volume and I/E ratio were significantly higher in RVF+ (9.7 +/- A 2.8 vs. 8.6 +/- A 1.8 ml m(-2) and 0.7 +/- A 0.5 vs. 0.5 +/- A 0.2). Plateau pressure tended to be higher in RVF+ (28 +/- A 6 vs. 25 +/- A 6 cmH(2)O, NS). In multivariate analysis, PaO2/FiO(2), mean arterial pressure, arterial pH, SvO(2), MPAP and presence of CVP > PAOP, but not RVF, were independently associated with day-90 mortality. In this group of patients investigated early in the course of ARDS and ventilated according to a strategy aimed at limiting plateau pressure, the presence of RVF was about 10%. Unlike MPAP and the presence of CVP > PAOP, RVF at this early stage did not appear as an independent factor of mortality.
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