title: Rationale and Description of Right Ventricle-Protective Ventilation in ARDS.
abstract: 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.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France. Faculty of Medicine, University of Versailles Saint-Quentin en Yvelines, Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Paternot
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Repessé
authors.affiliation: Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France. Faculty of Medicine, University of Versailles Saint-Quentin en Yvelines, Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France. INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France. antoine.vieillard-baron@aphp.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Vieillard-Baron
mesh_terms: D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D056888:Patient Positioning; D016684:Prone Position; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000503:physiopathology / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000517:prevention & control*; D016278:Ventricular Function, Right
keywords: ARDS; acute cor pulmonale; mechanical ventilation; prone positioning; right ventricle