RT Journal Article
SR Electronic
T1 Rationale and Description of Right Ventricle-Protective Ventilation in ARDS
JF Respiratory Care
FD American Association for Respiratory Care
SP 1391
OP 1396
DO 10.4187/respcare.04943
VO 61
IS 10
A1 Paternot, Alexis
A1 Repessé, Xavier
A1 Vieillard-Baron, Antoine
YR 2016
UL http://rc.rcjournal.com/content/61/10/1391.abstract
AB Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2, and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation.