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. 2017 Mar;45(3):422-429.
doi: 10.1097/CCM.0000000000002186.

Pulmonary Arterial Compliance in Acute Respiratory Distress Syndrome: Clinical Determinants and Association With Outcome From the Fluid and Catheter Treatment Trial Cohort

Thomas S Metkus  1 , Emmanouil Tampakakis, Christopher J Mullin, Brian A Houston, Todd M Kolb, Stephen C Mathai, Rachel Damico, Bradley A Maron, Paul M Hassoun, Roy G Brower, Ryan J Tedford
Affiliations

Pulmonary Arterial Compliance in Acute Respiratory Distress Syndrome: Clinical Determinants and Association With Outcome From the Fluid and Catheter Treatment Trial Cohort

Thomas S Metkus et al. Crit Care Med. 2017 Mar.

Abstract

Objectives: Pulmonary vascular dysfunction is associated with adverse prognosis in patients with the acute respiratory distress syndrome; however, the prognostic impact of pulmonary arterial compliance in acute respiratory distress syndrome is not established.

Design, setting, patients: We performed a retrospective analysis of 363 subjects with acute respiratory distress syndrome who had complete baseline right heart catheterization data from the Fluid and Catheter Treatment Trial to test whether pulmonary arterial compliance at baseline and over the course of treatment predicted mortality.

Main results: Baseline pulmonary arterial compliance (hazard ratio, 1.18 per interquartile range of 1/pulmonary arterial compliance; 95% CI, 1.02-1.37; p = 0.03) and pulmonary vascular resistance (hazard ratio, 1.28 per interquartile range; 95% CI, 1.07-1.53; p = 0.006) both modestly predicted 60-day mortality. Baseline pulmonary arterial compliance remained predictive of mortality when pulmonary vascular resistance was in the normal range (p = 0.02). Between day 0 and day 3, pulmonary arterial compliance increased in acute respiratory distress syndrome survivors and remained unchanged in nonsurvivors, whereas pulmonary vascular resistance did not change in either group. The resistance-compliance product (resistance-compliance time) increased in survivors compared with nonsurvivors, suggesting improvements in right ventricular load.

Conclusions: Baseline measures of pulmonary arterial compliance and pulmonary vascular resistance predict mortality in acute respiratory distress syndrome, and pulmonary arterial compliance remains predictive even when pulmonary vascular resistance is normal. Pulmonary arterial compliance and right ventricular load improve over time in acute respiratory distress syndrome survivors. Future studies should assess the impact of right ventricular protective acute respiratory distress syndrome treatment on right ventricular afterload and outcome.

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Figures

Figure 1
Figure 1
Panel A) CPA plotted as a function of PVR for the entire cohort. Panel B): CPA as a function of PVR stratified by PAWP. (P < 0.0001 for comparison of curves after log-log transformation).
Figure 1
Figure 1
Panel A) CPA plotted as a function of PVR for the entire cohort. Panel B): CPA as a function of PVR stratified by PAWP. (P < 0.0001 for comparison of curves after log-log transformation).
Figure 2
Figure 2
Panel A) Kaplan-Meier survival curve for initial pulmonary vascular resistance (PVR) dichotomized by optimal cutpoint. Panel B) Kaplan-Meier survival curve for initial 1/CPA dichotomized by optimal cutpoint
Figure 2
Figure 2
Panel A) Kaplan-Meier survival curve for initial pulmonary vascular resistance (PVR) dichotomized by optimal cutpoint. Panel B) Kaplan-Meier survival curve for initial 1/CPA dichotomized by optimal cutpoint
Figure 3
Figure 3
Panel A) Mean CPA on each of the first 4 trial days for subjects with available data at all 4 points who survived (N=209) versus those who died (N=71). CPA did not change over time for non-survivors (P = 0.9 for trend) whereas it increased over time in survivors (P = 0.02 for trend).Panel B) Mean PVR on each of the first 4 trial days for subjects with available data at all 4 points who survived (N=194) versus those who died (N=68). PVR did not change in survivors (P = 0.1 for trend) or non-survivors (P = 0.6 for trend).
Figure 3
Figure 3
Panel A) Mean CPA on each of the first 4 trial days for subjects with available data at all 4 points who survived (N=209) versus those who died (N=71). CPA did not change over time for non-survivors (P = 0.9 for trend) whereas it increased over time in survivors (P = 0.02 for trend).Panel B) Mean PVR on each of the first 4 trial days for subjects with available data at all 4 points who survived (N=194) versus those who died (N=68). PVR did not change in survivors (P = 0.1 for trend) or non-survivors (P = 0.6 for trend).
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References

    1. Ware LB, Matthay MA. The acute respiratory distress syndrome. The New England journal of medicine. 2000;342(18):1334–1349. - PubMed
    1. Maybauer MO, Maybauer DM, Herndon DN. Incidence and outcomes of acute lung injury. The New England journal of medicine. 2006;354(4):416–417. author reply 416-417. - PubMed
    1. Sweatt AJ, Levitt JE. Evolving epidemiology and definitions of the acute respiratory distress syndrome and early acute lung injury. Clinics in chest medicine. 2014;35(4):609–624. - PubMed
    1. Boissier F, Katsahian S, Razazi K, et al. Prevalence and prognosis of cor pulmonale during protective ventilation for acute respiratory distress syndrome. Intensive care medicine. 2013;39(10):1725–1733. - PubMed
    1. Mekontso Dessap A, Boissier F, Charron C, et al. Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive care medicine. 2015 - PubMed

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