Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis

Crit Care Med. 2001 Aug;29(8):1551-5. doi: 10.1097/00003246-200108000-00009.


Context: The incidence of acute cor pulmonale (ACP), a frequent and usually lethal complication of acute respiratory distress syndrome (ARDS) during traditional respiratory support, has never been re-evaluated since protective ventilation gained acceptance.

Objective: We performed a longitudinal transesophageal echocardiographic (TEE) study to determine whether this incidence, and its severe implications for prognosis, might have changed in our unit as we altered respiratory strategy.

Design: Prospective open clinical study.

Setting: Medical intensive care unit of a university hospital.

Patients: Seventy-five consecutive ARDS patients given respiratory support with airway pressure limitation (plateau pressure < or =30 cm H2O).

Interventions: ACP was defined as a ratio of right ventricular end-diastolic area to left ventricular end-diastolic area in the long axis >0.6 associated with septal dyskinesia in the short axis during TEE examination.

Results: Normal right ventricular function was present in 56 patients, whereas right ventricular dysfunction was observed in 19 patients after 2 days of respiratory support. ACP was associated with pulmonary artery hypertension, increased heart rate, and decreased stroke index. Significant impairment of left ventricular diastolic function was also seen. All echo-Doppler abnormalities were reversible in patients who recovered, and the mortality rate was the same in both groups (32%). However, ACP patients who recovered required a longer period of respiratory support. A multivariate analysis individualized Paco2 level as the sole factor independently associated with ACP, suggesting that ACP development in ARDS is influenced by the severity of lung damage and/or the respiratory strategy.

Conclusion: Evaluation of right ventricular function by TEE in a group of 75 ARDS patients submitted to protective ventilation revealed the persistence of a 25% incidence of ACP, resulting in detrimental hemodynamic consequences associated with tachycardia. However, ACP was reversible in patients who recovered and did not increase mortality.

MeSH terms

  • Echocardiography, Transesophageal*
  • Female
  • Hemodynamics*
  • Humans
  • Incidence
  • Logistic Models
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Pulmonary Heart Disease / diagnostic imaging
  • Pulmonary Heart Disease / epidemiology
  • Pulmonary Heart Disease / etiology*
  • Respiration, Artificial*
  • Respiratory Distress Syndrome / complications*
  • Respiratory Distress Syndrome / therapy