Right Ventricular Function in ARDS Patients

In Brief This review reiterates the importance of analyzing right ventricular (RV) function in acute respiratory distress syndrome. RV dysfunction is reported in 25% of patients submitted to protective mechanical ventilation. It takes the pattern of acute cor pulmonale and is strongly dependent on plateau pressure: the higher the plateau pressure the greater the risk of acute cor pulmonale. Whereas RV function must be evaluated using the pulmonary artery catheter, the most valuable tool is echocardiography by a transthoracic or transesophageal route. This is now recommended by the French Society of Intensive Care Medicine. In practice, we perform transesophageal echocardiography at least once a day during the first 3 to 4 days. This allows us to optimize hemodynamic treatment, but also ventilatory settings according to RV function. Any RV dysfunction prompts us to more decrease plateau pressure, to limit positive end-expiratory pressure, to decrease hypercapnia by reducing instrumental dead space, and to consider prone positioning. All are proven to be RV protective. This review reiterates the importance of analyzing right ventricular (RV) function in acute respiratory distress syndrome. Whereas RV function must be evaluated using the pulmonary artery catheter, the most valuable tool is echocardiography by a transthoracic or transesophageal route. Any RV dysfunction prompts us to decrease plateau pressure, to limit PEEP, to decrease hypercapnia by reducing instrumental dead space and to consider prone positioning. All are proven to be RV protective.