title: The Right Ventricle in ARDS.
abstract: ARDS is associated with poor clinical outcomes, with a pooled mortality rate of approximately 40% despite best standards of care. Current therapeutic strategies are based on improving oxygenation and pulmonary compliance while minimizing ventilator-induced lung injury. It has been demonstrated that relative hypoxemia can be well tolerated, and improvements in oxygenation do not necessarily translate into survival benefit. Cardiac failure, in particular right ventricular dysfunction (RVD), is commonly encountered in moderate to severe ARDS and is reported to be one of the major determinants of mortality. The prevalence rate of echocardiographically evident RVD in ARDS varies across studies, ranging from 22% to 50%. Although there is no definitive causal relationship between RVD and mortality, severe RVD is associated with increased mortality. Factors that can adversely affect RV function include hypoxic pulmonary vasoconstriction, hypercapnia, and invasive ventilation with high driving pressure. It might be expected that early diagnosis of RVD would be of benefit; however, echocardiographic markers (qualitative and quantitative) used to prospectively evaluate the right ventricle in ARDS have not been tested in adequately powered studies. In this review, we examine the prognostic implications and pathophysiology of RVD in ARDS and discuss available diagnostic modalities and treatment options. We aim to identify gaps in knowledge and directions for future research that could potentially improve clinical outcomes in this patient population.
authors.affiliation: Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston; Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham. Electronic address: vasileioszochios@doctors.org.uk.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Zochios
authors.affiliation: Department of Critical Care Medicine, the University of Calgary, Calgary, AB, Canada.
authors.forename: Ken
authors.initials: K
authors.lastname: Parhar
authors.affiliation: Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Edgbaston.
authors.forename: William
authors.initials: W
authors.lastname: Tunnicliffe
authors.affiliation: Department of Cardiothoracic Anesthesia and Critical Care Medicine, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge.
authors.forename: Andrew
authors.initials: A
authors.lastname: Roscoe
authors.affiliation: Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham; Academic Department of Anesthesia, Critical Care, Pain and Resuscitation, Heart of England NHS Foundation Trust, Birmingham, England, and The 2nd Affiliated Hospital and Yuying Children's Hospital Wenzhou Medical University, Wenzhou, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
mesh_terms: D019468:Disease Management; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
keywords: ARDS; cor pulmonale; critical care echocardiography; right ventricular dysfunction