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Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome

Armand Mekontso Dessap| Cyril Charron| Jérôme Devaquet| Jérôme Aboab| François Jardin| Laurent Brochard| Antoine Vieillard-Baron
Original
Volume 35, Issue 11 / November , 2009

Pages 1850 - 1858

Abstract

Purpose

To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (Pplat) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function.

Methods

Prospective observational study in two academic intensive care units enrolling 11 adults with severe ARDS (PaO2/FiO2 <150 mmHg at PEEP >5 cmH2O). We compared three ventilatory strategies, each used for 1 h, with Pplat at 22 (20–25) cmH2O: low PEEP (5.4 cmH2O) or high PEEP (11.0 cmH2O) with compensation of the tidal volume reduction by either a high respiratory rate (high PEEP/high rate) or instrumental dead space decrease (high PEEP/low rate). We assessed RV function (transesophageal echocardiography), alveolar dead space (expired CO2), and alveolar recruitment (pressure–volume curves).

Results

Compared to low PEEP, PaO2/FiO2 ratio and alveolar recruitment were increased with high PEEP. Alveolar dead space remained unchanged. Both high-PEEP strategies induced higher PaCO2 levels [71 (60–94) and 75 (53–84), vs. 52 (43–68) mmHg] and lower pH values [7.17 (7.12–7.23) and 7.20 (7.16–7.25) vs. 7.30 (7.24–7.35)], as well as RV dilatation, LV deformation and a significant decrease in cardiac index. The decrease in stroke index tended to be negatively correlated to the increase in alveolar recruitment with high PEEP.

Conclusions

Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant Pplat were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment (

  • ClinicalTrials.gov
  • #NCT00236262).

    Keywords

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