The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

by Ryota Sato, Siddharth Dugar, Wisit Cheungpasitporn, Mary Schleicher, Patrick Collier, Saraschandra Vallabhajosyula and Abhijit Duggal 

Critical Care volume 25, Article number: 172 (2021)

Background

Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS.

Method

We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients’ and studies’ characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90 days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30 days.

Results

We included 9 studies (N = 1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.13–1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR 1.48, 95% CI 1.14–1.93, p-value = 0.003, I2 = 0%).

Conclusion

In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality.

Percutaneous right ventricular assist device, rapid employment in right ventricular failure during septic shock

 

Percutaneous right ventricular assist device, rapid employment in right ventricular failure during septic shock

 

by Ignazio Condello 

 

Critical Care volume 24, Article number: 674 (2020) Published: 02 December 2020

 

 

Right ventricular (RV) failure, defined by critical care echocardiography Right Ventricular dilatation) and a surrogate of venous congestion (Central Venous Pressure ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant pulse pressure variation (PPV). Right Heart Failure with invasive ventricular device is associated with significant morbidity and mortality. A new generation of percutaneous right ventricular assist devices (RVADs) may mitigate the need for invasive surgical RVAD implantation. The Protek Duo (TPD) temporary RVAD, capable of providing up to 4.5 L/min, is a dual-lumen cannula inserted via the right internal jugular vein, with its proximal inflow lumen positioned in the right atrium and distal lumen positioned in the main pulmonary artery…