• Armand Mekontso Dessap, Florence Boissier, Cyril Charron, Emmanuelle Bégot, Xavier Repessé, Annick Legras, Christian Brun-Buisson, Philippe Vignon, and Antoine Vieillard-Baron.
• Service de Réanimation Médicale, DHU ATVB, Hôpitaux Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51 Av Mal de Lattre de Tassigny, 94010, Créteil Cedex, France. armand.dessap@aphp.fr.
• Intensive Care Med. 2016 May 1; 42 (5): 862-870.

RationaleIncreased right ventricle (RV) afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP).ObjectivesTo determine the prevalence and prognosis of ACP and build a clinical risk score for the early detection of ACP.MethodsThis was a prospective study in which 752 patients with moderate-to-severe ARDS receiving protective ventilation were assessed using transesophageal echocardiography in 11 intensive care units. The study cohort was randomly split in a derivation (n = 502) and a validation (n = 250) cohort.Measurements And Main ResultsACP was defined as septal dyskinesia with a dilated RV [end-diastolic RV/left ventricle (LV) area ratio >0.6 (≥1 for severe dilatation)]. ACP was found in 164 of the 752 patients (prevalence of 22 %; 95 % confidence interval 19-25 %). In the derivation cohort, the ACP risk score included four variables [pneumonia as a cause of ARDS, driving pressure ≥18 cm H2O, arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ratio <150 mmHg, and arterial carbon dioxide partial pressure ≥48 mmHg]. The ACP risk score had a reasonable discrimination and a good calibration. Hospital mortality did not differ between patients with or without ACP, but it was significantly higher in patients with severe ACP than in the other patients [31/54 (57 %) vs. 291/698 (42 %); p = 0.03]. Independent risk factors for hospital mortality included severe ACP along with male gender, age, SAPS II, shock, PaO2/FiO2 ratio, respiratory rate, and driving pressure, while prone position was protective.ConclusionsWe report a 22 % prevalence of ACP and a poor outcome of severe ACP. We propose a simple clinical risk score for early identification of ACP that could trigger specific therapeutic strategies to reduce RV afterload.

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