Detection of Right Ventricular Dysfunction by 2D Strain During Acute Respiratory Distress Syndrom (ARDS)

University Hospital, Grenoble47 enrolled

Overview

Acute respiratory distress syndrome (ARDS) and mechanical ventilation can lead to right ventricular dysfunction and ultimately right ventricular failure by increasing pulmonary vascular resistances and pressure load. This can be prevented by modifying ventilator settings, using vasopressors or inotropes or even by prone positionning.But to do so, right ventricular dysfonction has to be detected. Echocardiography has emerged as a first line tool to diagnose right heart failure. Recently, strain analysis showed promising results to detect early right ventricle abnormalities in other settings such as pulmonary hypertension or scleroderma. We therefore decided to determine whether 2D strain could help detect early right ventricular dysfunction in ARDS.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Acute Respiratory Distress Syndrome Right Ventricular Dysfunction Right Heart Failure Acute Cor Pulmonale

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

ARDS group Inclusion Criteria: * Need for mechanical ventilation * ARDS criteria met: Respiratory failure not fully explained by cardiac failure, Pao2/FiO2\<200, bilateral opacities on Chest imaging, all symptoms appeared within 1 week Exclusion Criteria: * Predictable duration of mechanical ventilation shorter than 48 hours * Contraindication to transesophageal echocardiography ALI group: Inclusion Criteria: * Need for mechanical ventilation * ALI criteria met: Respiratory failure not fully explained by cardiac failure, Pao2/FiO2\<300, bilateral opacities on Chest imaging, all symptoms appeared within 1 week Exclusion Criteria: * Predictable duration of mechanical ventilation shorter than 48 hours Control Group: Inclusion Criteria: * Need for mechanical ventilation for a non-respiratory cause Exclusion Criteria: * Need for FiO2\>30% * Known cardiac abnormalities * Cardiac drugs intake during last 24 hours

Outcomes

Primary Outcomes

Right ventricle 2D strain

We will assess whether 2D strain can detect a right ventricular dysfunction as compared to standard echocardiographic parameters

Time frame: Duration of mechanical ventilation

Secondary Outcomes

Mean right ventricle strain under ventilated patients

We measure right ventricle strain (RV strain) in patients under mechanical ventilation for a non-respiratory cause. This allows us to determine the mean value of RV strain under ventilation when there is no respiratory failure.

Time frame: at inclusion

Reproducibility between transthoracic and transesophageal strain measures

In ARDS patients, we record a transthoracic and transesophageal echocardiography. We compare RV strain values obtained from transthoracic and transesophageal echocardiography.

Time frame: Time of mechanical ventilation

NT pro BNP and pre pro endothelin plasma level

These assays are made based on the hypothesis they could help discriminate between patients who will develop a right ventricular dysfunction from those who will not. A blood sample is withdrawn at the same time as echocardiography only in the ARDS group.

Time frame: At inclusion in ARDS patients