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. 2015 Dec;5(1):25.
doi: 10.1186/s13613-015-0068-6. Epub 2015 Sep 17.

Right over left ventricular end-diastolic area relevance to predict hemodynamic intolerance of high-frequency oscillatory ventilation in patients with severe ARDS

Lionel Ursulet  1 , Arnaud Roussiaux  2 , Dominique Belcour  3 , Cyril Ferdynus  4 , Bernard-Alex Gauzere  5 , David Vandroux  6 , Julien Jabot  7
Affiliations

Right over left ventricular end-diastolic area relevance to predict hemodynamic intolerance of high-frequency oscillatory ventilation in patients with severe ARDS

Lionel Ursulet et al. Ann Intensive Care. 2015 Dec.

Abstract

Background: High-frequency oscillatory ventilation (HFOV) does not improve the prognosis of ARDS patients despite an improvement in oxygenation. This paradox may partly be explained by HFOV hemodynamic side-effects on right ventricular function. Our goal was to study the link between HFOV and hemodynamic effects and to test if the pre-HFOV right over left ventricular end-diastolic area (RVEDA/LVEDA) ratio, as a simple parameter of afterload-related RV dysfunction, could be used to predict HFOV hemodynamic intolerance in patients with severe ARDS.

Methods: Twenty-four patients were studied just before and within 3 h of HFOV using transthoracic echocardiography and transpulmonary thermodilution.

Results: Before HFOV, the mean PaO2/FiO2 ratio was 89 ± 23. The number of patients with a RVEDA/LVEDA ratio >0.6 significantly increased after HFOV [11 (46 %) vs. 17 (71 %)]. Although HFOV did not significantly decrease the arterial pressure (systolic, diastolic, mean and pulse pressure), it significantly decreased the cardiac index (CI) by 13 ± 18 % and significantly increased the RVEDA/LVEDA ratio by 14 ± 11 %. A significant correlation was observed between pre-HFOV RVEDA/LVEDA ratio and CI diminution after HFOV (r = 0.78; p < 0.0001). A RVEDA/LVEDA ratio superior to 0.6 resulted in a CI decrease >15 % during HFOV with a sensitivity of 80 % (95 % confidence interval 44-98 %) and a specificity of 79 % (confidence interval 49-95 %).

Conclusion: The RVEDA/LVEDA ratio measured just before HFOV predicts the hemodynamic intolerance of this technique in patients with severe ARDS. A high ratio under CMV raises questions about the use of HFOV in such patients.

Trial registration: ClinicalTrials.gov: NCT01167621.

Keywords: Acute respiratory distress syndrome; Acute right ventricular dysfunction; Echocardiography; Hemodynamic monitoring; High-frequency oscillatory ventilation; Transpulmonary thermodilution.

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Figures

Fig. 1
Fig. 1
Inverse correlation between the right over left ventricular end-diastolic area at inclusion and changes in cardiac index during HFOV. Line linear regression line
Fig. 2
Fig. 2
Receiver operating characteristic curve showing the ability of the right over left ventricular end-diastolic area at inclusion to detect a cardiac index decrease ≥15 % during HFOV. RVEDA right ventricular end diastolic area, LVEDA left ventricular end diastolic area
See this image and copyright information in PMC

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