Detection of Right Ventricular Dysfunction by 2D Strain During Acute Respiratory Distress Syndrom (ARDS)

Detection of Right Ventricular Dysfunction by 2D Strain During Acute Respiratory Distress Syndrom (ARDS)

Acute respiratory distress syndrome (ARDS) and mechanical ventilation can lead to right ventricular dysfunction and ultimately right ventricular failure by increasing pulmonary vascular resistances and pressure load. This can be prevented by modifying ventilator settings, using vasopressors or inotropes or even by prone positionning.But to do so, right ventricular dysfonction has to be detected. Echocardiography has emerged as a first line tool to diagnose right heart failure. Recently, strain analysis showed promising results to detect early right ventricle abnormalities in other settings such as pulmonary hypertension or scleroderma. We therefore decided to determine whether 2D strain could help detect early right ventricular dysfunction in ARDS.

ARDS group

Inclusion Criteria:

• Need for mechanical ventilation
• ARDS criteria met: Respiratory failure not fully explained by cardiac failure, Pao2/FiO2<200, bilateral opacities on Chest imaging, all symptoms appeared within 1 week

Exclusion Criteria:

• Predictable duration of mechanical ventilation shorter than 48 hours
• Contraindication to transesophageal echocardiography

ALI group:

Inclusion Criteria:

• Need for mechanical ventilation
• ALI criteria met: Respiratory failure not fully explained by cardiac failure, Pao2/FiO2<300, bilateral opacities on Chest imaging, all symptoms appeared within 1 week

Exclusion Criteria:

• Predictable duration of mechanical ventilation shorter than 48 hours

Control Group:

Inclusion Criteria:

• Need for mechanical ventilation for a non-respiratory cause

Exclusion Criteria:

• Need for FiO2>30%
• Known cardiac abnormalities
• Cardiac drugs intake during last 24 hours