Driving pressure versus right ventricular echocardiography parameters as a predictive for acute respiratory distress syndrome outcome
Keywords:
driving pressure, echocardiography, distress syndromeAbstract
Background: Acute respiratory distress syndrome (ARDS) is an inflammatory disease that affects the lung in a heterogeneous manner , so that ,even ideal body weight (IBW) based tidal volume may apply different lung stress and strain according to the available aerated lung areas. Airway driving pressure (DP) is the difference between airway plateau pressure (P plat) and positive endexpiratory pressure (PEEP), it can be used as a bedside surrogate for lung stress in several previous studies. Acute corpulmonale manifested by pulmonary hypertension and right ventricular dysfunction occurs as a consequence for ARDS with a prevalence ( 25% to 61%) in different studies. Objectives : This study was designed to show he clinical value of airway driving pressure and right heart echocardiography parameters in predicting ARDS outcome , and to correlate between airway pressures and right ventricle parameters. Methodology : fifty ARDS patients were diagnosed by Berlin criteria and monitored for airway pressures including DP and Pplat on day 0, day 3 and day 7. transthoracic echocardiography was used to assess RV parameters on day 0 and day 7 . According the ICU mortality patients are divided into survivors and nonsurvivors.
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-Gattinoni L, Pesenti A. The concept of “baby lung”. Intensive Care Med. 2005;31:776–84.
-Chiumello D, Carlesso E, Cadringher P, Caironi P, Valenza F, Polli F, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med. 2008;178:346–55.
-Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354:1775–86.
-Gattinoni L, Carlesso E, Cadringher P, Valenza F, Vagginelli F, Chiumello D. Physical and biological triggers of ventilator-induced lung injury and its prevention. Eur Respir J Suppl 2003;47:15s–25s.
-Tschumperlin DJ, Oswari J, Margulies AS. Deformation-induced injury of alveolar epithelial cells: effect of frequency, duration, and amplitude. Am J Respir Crit Care Med 2000;162:357-362
-Garcia CS, Rocco PR, Facchinetti LD, et al. What increases type III procollagen mRNA levels in lung tissue: stress induced by changes in force or amplitude? Respir Physiol Neurobiol 2004;144:59-70
-Terragni PP, Rosboch G, Tealdi A, Corno E, Menaldo E, Davini O, Gandini G, Herrmann P, Mascia L, Quintel M, Slutsky AS, Gattinoni L, Ranieri VM (2007) Tidal hyperinflation during low tidal volume ventilation in acute respiratory distress syndrome. Am J Respir Crit Care Med 175:160–166
-Roupie E, Dambrosio M, Servillo G, et al. Titration of tidal volume and induced hypercapnia in acute respiratory distress syndrome. Am J Respir Crit Care Med 1995;152:121-128
-Brower R, Matthay MA, Schoenfeld DA. Meta-analysis of acute lung injury and acute respiratory distress syndrome trials. Am J Respir Crit Care Med 2002;166:1515-1516
-Brower R, Krishnan J, Thompson BT, et al. Effects of tidal volume reduction (VtR) in acute lung injury (ALI) patients with inspiratory plateau pressures (PPLAT) <32 CM H2O before VTR. Am J Respir Crit Care Med 2003;167:A616.abstract.
-Loring SH, Malhotra A. Driving pressure and respiratory mechanics in ARDS. N Engl J Med. 2015;372:776–7.
-Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al. The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189:520–31
-Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480
-Kopman EA, Ferguson TB (1985) Interaction of right and left ventricular filling pressures at the termination of cardiopulmonary bypass. Central venous pressure/pulmonary capillary wedge pressure ratio. J Thorac Cardiovasc Surg 89:706–708
-Ware LB, Matthay MA (2000) The acute respiratory distress syndrome. N Engl J Med 342:1334–1349
Tomashefski JF Jr, Davies P, Boggis C, Greene R, Zapol WM, Reid LM (1983) The pulmonary vascular lesions of the adult respiratory distress syndrome. Am J Pathol 112:112–126
-Leeman M (1991) The pulmonary circulation in acute lung injury: a review of some recent advances. Intensive Care Med 17:254–260
-Jardin F, Vieillard-Baron A (2007) Is there a safe plateau pressure in ARDS? The right heart only knows. Intensive Care Med 33:444–447
-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;13:952–956. doi: 10.1097/00003246-198511000-00035
-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;29:1551–1555. doi: 10.1097/00003246-200108000-00009
-ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA.2012 Jun 20. 307 (23):2526-33
- Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985). "APACHE II: a severity of disease classification system". Critical Care Medicine. 13 (10): 818
-Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, Reinhart CK, Suter PM, Thijs LG. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996 Jul;22(7):707-10
-Le Gall, JR; Lemeshow, S; Saulnier, F (1993). "A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study". JAMA. 270(24): 2957–63.
-Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W, American Society of Echocardiography's Nomenclature and Standards Committee., Task Force on Chamber Quantification., American College of Cardiology Echocardiography Committee., American Heart Association., and European Association of Echocardiography, European Society of Cardiology.. Recommendations for chamber quantification. Eur J Echocardiogr. 2006 Mar;7(2):79-108
-Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, and American Society of Echocardiography.. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003 Jul;16(7):777-802.
-McQuillan BM, Picard MH, Leavitt M, Weyman AE. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects. Circulation 2001; 104:2797–2802
-Murray JF, Matthay MA, Luce JM, Flick MR. An expanded definition of the adult respiratory distress syndrome. Am Rev Respir Dis. 1988;138:720–723.
-Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., arlos R.R. Carvalho, M.D., Driving Pressure and Survival in the Acute Respiratory Distress Syndrome; N Engl J Med 2015; 372:747-755
-Sandoval Driving pressure is the most predictive respiratory parameter in ARDS; 2016 Mexico city, ATS journal
Airway driving pressure and lung stress in ARDS patients Davide Chiumello1,2*, Eleonora Carlesso3 , Matteo Brioni3 and Massimo Cressoni3: Chiumello et al. Critical Care (2016) 20:276
-Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301-8. 10.1056/NEJM200005043421801.
-Seeley E, McAuley DF, Eisner M, Miletin M, Matthay MA, Kallet RH. Predictors of mortality in acute lung injury during the era of lung protective ventilation. Thorax. 2008;63:994–998.
-Bernard GR, Artigas A, Brigham KL. The American-European Consensus Conference on ARDS.Definitions, mechanisms, relevant outcomes, and clinical trial coordination.Am J RespirCrit Care Med. 1994 Mar. 149(3 Pt 1):818-24
-Comparison of clinical criteria for the acute respiratory distress syndrome with autopsy findings.Esteban A, Fernández-Segoviano P, Frutos-Vivar F, Aramburu JA, Nájera L, Ferguson ND, Alía I, Gordo F, Ríos F
Ann Intern Med. 2004 Sep 21; 141(6):440-5.
-Less is more: improved outcomes in surgical patients with conservative fluid administration and central venous catheter monitoring.Stewart RM, Park PK, Hunt JP, McIntyre RC Jr, McCarthy J, Zarzabal LA, Michalek JE, National Institutes of Health/National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Clinical Trials Network.J Am Coll Surg. 2009 May; 208(5):725-35; discussion 735-7.
-Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury.National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network., Wheeler AP, Bernard GR, Thompson BT, Schoenfeld D, Wiedemann HP, deBoisblanc B, Connors AF Jr, Hite RD, Harabin ALN Engl J Med. 2006 May 25; 354(21):2213-24
-Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.Esteban A, Anzueto A, Frutos F, Alía I, Brochard L, Stewart TE, Benito S, Epstein SK, Apezteguía C, Nightingale P, Arroliga AC, Tobin MJ, Mechanical Ventilation International Study Group.
JAMA. 2002 Jan 16; 287(3):345-55.
-Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients. SRLF Collaborative Group on Mechanical Ventilation. Société de Réanimation de Langue Française.Roupie E, Lepage E, Wysocki M, Fagon JY, Chastre J, Dreyfuss D, Mentec H, Carlet J, Brun-Buisson C, Lemaire F, Brochard LIntensive Care Med. 1999 Sep; 25(9):920-9.
-Echocardiographic parameters of right ventricular function predict mortality in acute respiratory distress syndrome: a pilot studyTrushil G. Shah, Subeer K. Wadia, Julie Kovach, Louis Fogg, Rajive TandonPulm Circ. 2016 Jun; 6(2): 155–160. doi: 10.1086/685549
PMCID:
-S.A. Ñamendys-Silva, L.E. Santos-Martínez, T. Pulido, E. Rivero-Sigarroa,J.A. Baltazar-Torres,G. Domínguez-Cherit, and J. Sandoval Pulmonary hypertension due to acute respiratory distress syndrome. 2014 Oct; 47(10): 904–910.
- Beiderlinden M, Kuehl H, Boes T, Peters J. Prevalence of pulmonary hypertension associated with severe acute respiratory distress syndrome: predictive value of computed tomography. Intensive Care Med. 2006;32:852–857
-Pulmonary hypertension in sepsis: measurement by the pulmonary arterial diastolic-pulmonary wedge pressure gradient and the influence of passive and active factors.Sibbald WJ, Paterson NA, Holliday RL, Anderson RA, Lobb TR, Duff JHChest. 1978 May; 73(5):583-91
David Osman,Xavier Monnet,Vincent Castelain,Nadia Anguel,Josiane Warszawski,Jean-Louis Teboul Incidence and prognostic value of right ventricular failure in acute respiratory distress syndrome Intensive Care MedicineJanuary 2009, Volume 35, Issue 1, pp 69–76
- Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive Care Med. 2013;39(10):1725-1733
- Lhéritier G, Legras A, Caille A, 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(10):1734-1742.
-Bull TM, Clark B, McFann K, MossM Pulmonary vascular dysfunction is associated with poor outcomes in patients with acute lung injury.Am J Respir Crit Care Med 182:1123–1128, 2010)
- Squara P, Dhainaut JF, Artigas A, Carlet J. Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS Study. Intensive Care Med. 1998;24:1018–1028.
Laghi F., Siegel J.H., Rivkind A.I., Chiarla C., DeGaetano A., Blevins S., Stoklosa J. C., Borg U. R., Belzberg H.Respiratory index/pulmonary shunt relationship: quantification of severity and prognosis in the post-traumatic adult respiratory distress syndrome. Crit. Care Med.17198911211128
-Steltzer H., Krafft P., Fridrich P., Hiesmayr M., Hammerle A. F.Right ventricular function and oxygen transport patterns in patients with acute respiratory distress syndrome. Anesthesia49199410391045
-Mekontso Dessap A, Boissier F, Charron C, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Med. 2016;42(5):862-870
-Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I, Dhainaut JF, Brunet F (1998) Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 158:1076–1081
- Cepkova M, Kapur V, Ren X, Quinn T, Zhuo H, Foster E, Liu KD, Matthay MA. Pulmonary dead space fraction and pulmonary artery systolic pressure as early predictors of clinical outcome in acute lung injury. Chest. 2007;132:836–842
- Wadia SK, Shah TG, Hedstrom G, Kovach JA, Tandon R. Early detection of right ventricular dysfunction using transthoracic echocardiography in ARDS: a more objective approach. Echocardiography. 2016;33(12):1874-1879.
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