Document Detail

Is there a safe plateau pressure in ARDS? The right heart only knows.
MedLine Citation:
PMID:  17268795     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Airway pressure limitation is now a largely accepted strategy in adult respiratory distress syndrome (ARDS) patients; however, some debate persists about the exact level of plateau pressure which can be safely used. The objective of the present study was to examine if the echocardiographic evaluation of right ventricular function performed in ARDS may help to answer to this question. DESIGN AND PATIENTS: For more than 20 years, we have regularly monitored right ventricular function by echocardiography in ARDS patients, during two different periods, a first (1980-1992) where airway pressure was not limited, and a second (1993-2006) where airway pressure was limited. By pooling our data, we can observe the effect of a large range of plateau pressure upon mortality rate and incidence of acute cor pulmonale. RESULTS: In this whole group of 352 ARDS patients, mortality rate and incidence of cor pulmonale were 80 and 56%, respectively, when plateau pressure was > 35 cmH(2)O; 42 and 32%, respectively, when plateau pressure was between 27 and 35 cmH(2)O; and 30 and 13%, respectively, when plateau pressure was < 27 cmH(2)O. Moreover, a clear interaction between plateau pressure and cor pulmonale was evidenced: whereas the odd ratio of dying for an increase in plateau pressure from 18-26 to 27-35 cm H(2)O in patients without cor pulmonale was 1.05 (p = 0.635), it was 3.32 in patients with cor pulmonale (p < 0.034). CONCLUSION: We hypothesize that monitoring of right ventricular function by echocardiography at bedside might help to control the safety of plateau pressure used in ARDS.
François Jardin; Antoine Vieillard-Baron
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Publication Detail:
Type:  Journal Article     Date:  2007-02-01
Journal Detail:
Title:  Intensive care medicine     Volume:  33     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2007 Mar 
Date Detail:
Created Date:  2007-02-27     Completed Date:  2007-07-11     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  444-7     Citation Subset:  IM    
Medical Intensive Care Unit, University Hospital Ambroise Paré, Assistance Publique Hôpitaux de Paris, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
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MeSH Terms
France / epidemiology
Odds Ratio
Partial Pressure
Prospective Studies
Pulmonary Heart Disease / epidemiology,  etiology,  prevention & control,  ultrasonography
Respiration, Artificial / adverse effects,  methods*
Respiratory Distress Syndrome, Adult / complications,  mortality,  therapy*
Tidal Volume
Ventricular Function, Right*

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