Document Detail

Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome.
MedLine Citation:
PMID:  20601861     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Right-to-left shunting across a patent foramen ovale may occur in acute respiratory distress syndrome as a result of pulmonary hypertension and positive-pressure mechanical ventilation. The shunt may worsen the hypoxemia. The objective of our study was to determine the prevalence, clinical implications, and prognosis of patent foramen ovale shunting during acute respiratory distress syndrome.
DESIGN: Prospective study.
SETTING: Medical intensive care unit of a university hospital in Créteil, France.
PATIENTS: Two hundred three consecutive patients with acute respiratory distress syndrome.
INTERVENTIONS: Patent foramen ovale shunting was detected by using transesophageal echocardiography with modified gelatin contrast. Moderate-to-large shunting was defined as right-to-left passage of at least 10 bubbles through a valve-like structure within three cardiac cycles after complete opacification of the right atrium. In 85 patients without and 31 with shunting, the influence of the positive end-expiratory pressure level on shunting was studied.
MEASUREMENTS AND RESULTS: The prevalence of moderate-to-large patent foramen ovale shunting was 19.2% (39 patients). Compared to those in the group without shunting, the patients in group with shunting had larger right ventricle dimensions, higher pulmonary artery systolic pressure, and a higher prevalence of cor pulmonale. Compared to patients without shunting, patients with shunting had a poorer Pa(O(2))/Fi(O(2)) ratio response to positive end-expiratory pressure, more often required prone positioning and nitric oxide as adjunctive interventions, and had fewer ventilator-free and intensive care unit-free days within the first 28 days.
CONCLUSIONS: Moderate-to-large patent foramen ovale shunting occurred in 19.2% of patients with acute respiratory distress syndrome, in keeping with findings from autopsy studies. Patent foramen ovale was associated with a poor oxygenation response to positive end-expiratory pressure, greater use of adjunctive interventions, and a longer intensive care unit stay.
Armand Mekontso Dessap; Florence Boissier; Rusel Leon; Serge Carreira; Ferran Roche Campo; François Lemaire; Laurent Brochard
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  38     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-09-27     Revised Date:  2011-03-23    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1786-92     Citation Subset:  AIM; IM    
AP-HP, Groupe Henri-Mondor Albert-Chenevier, Service de Réanimation Médicale, Créteil, France.
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MeSH Terms
Echocardiography, Transesophageal
Foramen Ovale, Patent / complications*
Heart Septal Defects, Atrial / complications*
Hypertension, Pulmonary / complications
Middle Aged
Nitric Oxide / administration & dosage
Positive-Pressure Respiration / adverse effects
Prospective Studies
Respiratory Distress Syndrome, Adult / complications*
Reg. No./Substance:
10102-43-9/Nitric Oxide
Comment In:
Crit Care Med. 2010 Sep;38(9):1909-10   [PMID:  20724889 ]
Crit Care Med. 2011 Mar;39(3):611-2; author reply 612   [PMID:  21330879 ]
Crit Care Med. 2011 Feb;39(2):420-1; author reply 421-2   [PMID:  21248533 ]

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