• Antoine Vieillard-Baron, Amélie Prigent, Xavier Repessé, Marine Goudelin, Gwenaël Prat, Bruno Evrard, Cyril Charron, Philippe Vignon, and Guillaume Geri.
• Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, Boulogne Billancourt, France. Antoine.vieillard-baron@aphp.fr.
• Crit Care. 2020 Nov 1; 24 (1): 630.

ObjectiveIncidence of right ventricular (RV) failure in septic shock patients is not well known, and tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values.DesignAncillary study of the HEMOPRED prospective multicenter study includes patients under mechanical ventilation with circulatory failure.SettingThis is a multicenter intensive care unit study PATIENTS: Two hundred and eighty-two patients with septic shock were analyzed. Patients were classified in three groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.InterventionsNone.Measurements And Main ResultsIn total, 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had a normal TAPSE.ConclusionsRV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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