• Jérôme Cecchini, Florence Boissier, Aude Gibelin, Nicolas de Prost, Keyvan Razazi, Guillaume Carteaux, Frederic Galacteros, Bernard Maitre, Christian Brun-Buisson, and Armand Mekontso Dessap.
• *Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, DHU ATVB, Service de Réanimation médicale, Créteil, France †Université Paris Est, Institut Mondor de recherche biomédicale - Groupe de recherche clinique CARMAS, Créteil, France ‡Assistance Publique - Hôpitaux de Paris, Hôpital Tenon, Unité de Réanimation médico-chirurgicale, Pôle Thorax Voies aériennes, Groupe hospitalier des Hôpitaux Universitaires de l'Est Parisien, Paris, France §Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Centre de référence des pathologies du globule rouge, Créteil, France.
• Shock. 2016 Oct 1; 46 (4): 358-64.

BackgroundAcute chest syndrome (ACS) is the most common cause of death among sickle cell disease (SCD) adult patients. Pulmonary vascular dysfunction (PVD) and acute cor pulmonale (ACP) are common during acute respiratory distress syndrome (ARDS) and their prevalence may be even more important during ARDS related to ACS (ACS-ARDS). The objective of this study was to evaluate the prevalence and prognosis of PVD and ACP during ACS-ARDS.Patients And MethodsThis was a retrospective analysis over a 10-year period of patients with moderate-to-severe ARDS. PVD and ACP were assessed by echocardiography. ARDS episodes were assigned to ACS-ARDS or nonACS-ARDS group according to whether the clinical insult was ACS or not, respectively. To evaluate independent factors associated with ACP, significant univariable risk factors were examined using logistic regression and propensity score analyses.ResultsA total of 362 patients were analyzed, including 24 ACS-ARDS. PVD and ACP were identified, respectively, in 24 (100%) and 20 (83%) ACS-ARDS patients, as compared with 204 (60%) and 68 (20%) nonACS-ARDS patients (P < 0.0001). The mortality did not differ between ACS-ARDS and nonACS-ARDS patients. Both the crude (odds ratio [OR], 19.9; 95% confidence interval [CI], 6.6-60; P < 0.0001), multivariable adjustment (OR, 27.4; 95% CI, 8.2-91.5; P < 0.001), and propensity-matched (OR, 11.7; 95% CI, 1.2-110.8; P = 0.03) analyses found a significant association between ACS-ARDS and ACP.ConclusionsAll SCD patients presenting with moderate-to-severe ARDS as a consequence of ACS experienced PVD and more than 80% of them exhibited ACP. These results suggest a predominant role for PVD in the pathogenesis of severe forms of ACS.

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