Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: a multicenter study

• DOI: 10.1007/s00134-013-3017-6
• Publication Date: 2013-07-16T16:25:50Z
• Authors: Gwenaëlle Lhéritier; Annick Legras; Agnès Caille; Thierry Lherm; Armelle Mathonnet; Jean-Pierre Frat; Anne Courte; Laurent Martin-Le...; Jean-Paul Gouëllo; Jean-Bernard Amiel; Denis Garot; Philippe Vignon
• Keywords: Respiratory Distress Syndrome; Foramen Ovale, Patent; Observation; Comorbidity; Middle Aged; Prognosis; 3. Good health; Positive-Pressure Respiration; Intensive Care Units; 03 medical and health sciences; 0302 clinical medicine; Pulmonary Heart Disease; Prevalence; Humans; France; Prospective Studies; Echocardiography, Transesophageal

We sought to determine the prevalence of and factors associated with acute cor pulmonale (ACP) patent foramen ovale (PFO) at early phase respiratory distress syndrome (ARDS), assess their relation mortality.In this prospective multicenter study, 200 patients submitted protective ventilation for moderate severe ARDS [PaO₂/F(I)O₂: 115 ± 39 F(I)O₂: 1; positive end-expiratory pressure (PEEP): 10.6 3.1 cmH2O] underwent transthoracic (TTE) transesophageal echocardiography (TEE) <48 h after admission. Echocardiograms were independently interpreted by two experts. Factors ACP, PFO, 28-day mortality identified using multivariate regression analysis.TEE depicted ACP in 45/200 [22.5%; 95% confidence interval (CI) 16.9-28.9%], PFO 31 (15.5%; CI 10.8-21.3%), both 9 (4.5%; 2.1-8.4%). shunting was small intermittent 27 patients, consistent 4 large or extensive no instances. PaCO₂ >60 mmHg strongly [odds ratio (OR) 3.70; 1.32-10.38; p = 0.01]. No factor only a trend age (OR 2.07; 0.91-4.72; 0.08). Twenty-eight-day 23%. Plateau 1.15; 1.05-1.26; < 0.01) air leaks 5.48; 1.30-22.99; 0.02), but neither nor outcome.TEE screening allowed identification one-fourth ARDS. less frequent never extensive. not related outcome.