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VOLUME 21 , ISSUE 6 ( 2017 ) > List of Articles

Meta-analysis

Incidence proportion of acute cor pulmonale in patients with acute respiratory distress syndrome subjected to lung protective ventilation: A systematic review and meta-analysis

Saurabh Kumar Das, Nang Sujali Choupoo, Amitabh Lahkar

Keywords : Acute cor pulmonale, acute respiratory distress syndrome, lung protective ventilation, mechanical ventilation, right ventricular dysfunction

Citation Information : Das SK, Choupoo NS, Lahkar A. Incidence proportion of acute cor pulmonale in patients with acute respiratory distress syndrome subjected to lung protective ventilation: A systematic review and meta-analysis. Indian J Crit Care Med 2017; 21 (6):364-375.

DOI: 10.4103/ijccm.IJCCM_155_17

License: CC BY-ND 3.0

Published Online: 01-06-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Reported incidence of acute cor pulmonale (ACP) in patients with acute respiratory distress syndrome (ARDS) varies from 10% to 84%, despite being subjected to lung protective ventilation according to the current guidelines. The objective of this review is to find pooled cumulative incidence of ACP in patients with ARDS undergoing lung protective ventilation. Materials and Methods: We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILACS, and WHO Clinical Trial Registry. Cross-sectional or cohort studies were included if they reported or provided data that could be used to calculate the incidence proportion of ACP. Inverse variance heterogeneity (IVhet) and random effect model were used for the main outcome and measures. Results: We included 16 studies encompassing 1661 patients. The cumulative incidence of ACP using IVhet analysis was 23% (95% confidence interval [CI] = 18%–28%) over 3 days of lung protective ventilation. Random effect analysis of 7 studies (1250 patients) revealed pooled odd ratio of mortality of 1.16 (95% CI = 0.80-1.67, P = 0.44) due to ACP. Conclusion: Patients with ARDS have a 23% risk of developing ACP with lung protective ventilation. Findings of this review indicate the need of updating existing guidelines for ventilating ARDS patients to incorporate right ventricle protective strategy. PROSPERO registration number: CRD42017054688.


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  1. Zapol WM, Snider MT. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 1977;296:476-80.
  2. Repessé X, Charron C, Vieillard-Baron A. Acute cor pulmonale in ARDS: Rationale for protecting the right ventricle. Chest 2015;147:259-65.
  3. Jardin F, Gueret P, Dubourg O, Farcot JC, Margairaz A, Bourdarias JP. Two-dimensional echocardiographic evaluation of right ventricular size and contractility in acute respiratory failure. Crit Care Med 1985;13:952-6.
  4. ARDSnet NIH NHLBI ARDS Network Mechanical Ventilation Protocol Summary. Available from: http://www.ardsnet.org/files/ventilator_protocol_2008_07.pdf. [Last accessed on 2016 Dec 18].
  5. Vieillard-Baron A, Schmitt JM, Augarde R, Fellahi JL, Prin S, Page B, et al. Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: Incidence, clinical implications, and prognosis. Crit Care Med 2001;29:1551-5.
  6. Page B, Vieillard-Baron A, Beauchet A, Aegerter P, Prin S, Jardin F. Low stretch ventilation strategy in acute respiratory distress syndrome: Eight years of clinical experience in a single center. Crit Care Med 2003;31:765-9.
  7. Thierry S, Lecuyer L, Brocas E, Van de Louw A, Hours S, Moreau MH, et al. Interest of the brain natriuretic peptide as a marker of acute cor pulmonale in acute respiratory distress syndrome. Ann Fr Anesth Reanim 2006;25:815-9.
  8. Vieillard-Baron A, Charron C, Caille V, Belliard G, Page B, Jardin F. Prone positioning unloads the right ventricle in severe ARDS. Chest 2007;132:1440-6.
  9. Jardin F, Vieillard-Baron A. Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med 2007;33:444-7.
  10. Osman D, Monnet X, Castelain V, Anguel N, Warszawski J, Teboul JL, et al. Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome. Intensive Care Med 2009;35:69-76.
  11. Fougères E, Teboul JL, Richard C, Osman D, Chemla D, Monnet X. Hemodynamic impact of a positive end-expiratory pressure setting in acute respiratory distress syndrome: Importance of the volume status. Crit Care Med 2010;38:802-7.
  12. Brown SM, Pittman J, Miller Iii RR, Horton KD, Markewitz B, Hirshberg E, et al. Right and left heart failure in severe H1N1 influenza A infection. Eur Respir J 2011;37:112-8.
  13. Guervilly C, Forel JM, Hraiech S, Demory D, Allardet-Servent J, Adda M, et al. Right ventricular function during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care Med 2012;40:1539-45.
  14. Fichet J, Moreau L, Genée O, Legras A, Mercier E, Garot D, et al. Feasibility of right ventricular longitudinal systolic function evaluation with transthoracic echocardiographic indices derived from tricuspid annular motion: A preliminary study in acute respiratory distress syndrome. Echocardiography 2012;29:513-21.
  15. Lhéritier G, Legras A, Caille A, Lherm T, Mathonnet A, Frat JP, et al. Prevalence and prognostic value of acute cor pulmonale and patent foramen ovale in ventilated patients with early acute respiratory distress syndrome: A multicenter study. Intensive Care Med 2013;39:1734-42.
  16. Boissier F, Katsahian S, Razazi K, Thille AW, Roche-Campo F, Leon R, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med 2013;39:1725-33.
  17. Ñamendys-Silva SA, Santos-Martínez LE, Pulido T, Rivero-Sigarroa E, Baltazar-Torres JA, Domínguez-Cherit G, et al. Pulmonary hypertension due to acute respiratory distress syndrome. Braz J Med Biol Res 2014;47:904-10.
  18. Legras A, Caille A, Begot E, Lhéritier G, et al. Acute respiratory distress syndrome (ARDS)-associated acute cor pulmonale and patent foramen ovale: A multicenter noninvasive hemodynamic study. Crit Care 2015;19:174.
  19. Mekontso Dessap A, Repessé X, Boissier F, Legras A, Charron C, Bégot E, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: Prevalence, predictors, and clinical impact. Intensive Care Med 2016;42:862-70.
  20. Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Terenzi P, Bernardo P, et al. Right ventricle dilation as a prognostic factor in refractory acute respiratory distress syndrome requiring veno-venous extracorporeal membrane oxygenation. Minerva Anestesiol 2016;82:1043-9.
  21. Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Terenzi P, Bernardo P, et al. Pulmonary vascular dysfunction in refractory acute respiratory distress syndrome before veno-venous extracorporeal membrane oxygenation. Acta Anaesthesiol Scand 2016;60:485-91.
  22. Lazzeri C, Bonizzoli M, Cozzolino M, Verdi C, Cianchi G, Batacchi S, et al. Serial measurements of troponin and echocardiography in patients with moderate-to-severe acute respiratory distress syndrome. J Crit Care 2016;33:132-6.
  23. Das SK, Choupoo NS, Saikia P, Lahakar A. Incidence Proportion of Acute Cor Pulmonale in Patients with Acute Respiratory Distress Syndrome Subjected to Lung Protective Ventilation: A Systematic Reviews and Meta Analysis. PROSPERO: International Prospective Register of Systematic Reviews. Available from: https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017054688. [Last accessed on 2017 May 26].
  24. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
  25. Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C. Methodological guidance for systematic reviews of observational epidemiological studies reporting prevalence and cumulative incidence data. Int J Evid Based Healthc 2015;13:147-53.
  26. Doi SA, Barendregt JJ, Khan S, Thalib L, Williams GM. Advances in the meta-analysis of heterogeneous clinical trials I: The inverse variance heterogeneity model. Contemp Clin Trials 2015;45(Pt A):130-8.
  27. Barendregt JJ, Doi SA, Lee YY, Norman RE, Vos T. Meta-analysis of prevalence. J Epidemiol Community Health 2013;67:974-8.
  28. Review Manager (RevMan) [Computer Program]. Version 5.3. Copenhagen: The Nordic Cochrane, The Cochrane Collaboration; 2014.
  29. Petrucci N, De Feo C. Lung protective ventilation strategy for the acute respiratory distress syndrome. Cochrane Database Syst Rev 2013;2:CD003844.
  30. Hoeper MM, Bogaard HJ, Condliffe R, Frantz R, Khanna D, Kurzyna M, et al. Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 2013;62 25 Suppl: D42-50.
  31. Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD, Chandrasekaran K, et al. Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography. J Am Soc Echocardiogr 2010;23:685-713.
  32. Mekontso Dessap A, Charron C, Devaquet J, Aboab J, Jardin F, Brochard L, et al. Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome. Intensive Care Med 2009;35:1850-8.
  33. Amato MB, Meade MO, Slutsky AS, Brochard L, Costa EL, Schoenfeld DA, et al. Driving pressure and survival in the acute respiratory distress syndrome. N Engl J Med 2015;372:747-55.
  34. Vieillard-Baron A, Prin S, Chergui K, Dubourg O, Jardin F. Echo-doppler demonstration of acute cor pulmonale at the bedside in the medical intensive care unit. Am J Respir Crit Care Med 2002;166:1310-9.
  35. Lazzeri C, Cianchi G, Bonizzoli M, Batacchi S, Peris A, Gensini GF. The potential role and limitations of echocardiography in acute respiratory distress syndrome. Ther Adv Respir Dis 2016;10:136-48.
  36. Vieillard-Baron A, Slama M, Mayo P, Charron C, Amiel JB, Esterez C, et al. A pilot study on safety and clinical utility of a single-use 72-hour indwelling transesophageal echocardiography probe. Intensive Care Med 2013;39:629-35.
  37. Repessé X, Charron C, Vieillard-Baron A. Right ventricular failure in acute lung injury and acute respiratory distress syndrome. Minerva Anestesiol 2012;78:941-8.
  38. Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013;368:2159-68.
  39. Ferguson ND, Cook DJ, Guyatt GH, Mehta S, Hand L, Austin P, et al. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013;368:795-805.
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