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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: 01-06-2018

Copyright Statement:  Copyright © 2017; The Author(s).


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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