The impact of right ventricular injury on the mortality in patients with acute respiratory distress syndrome: a systematic review and meta-analysis

• Authors: Ryota Sato, Cleveland Clinic; Siddharth Dugar, Cleveland Clinic; Wisit Cheungpasitporn, Mayo Clinic, Rochester; Mary Schleicher, Cleveland Clinic; Patrick Collier, Cleveland Clinic; Saraschandra Vallabhajosyula, Emory University; Abhijit Duggal, Cleveland Clinic
• Journal Title: CRITICAL CARE
• Volume: Volume 25, Number 1
• Publisher: BMC | 2021-05-21, Pages 172-172
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s13054-021-03591-9
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Critical Care Medicine; General & Internal Medicine; Right ventricular dysfunction; Acute cor pulmonale; Acute respiratory distress syndrome; Acute lung injury; HEART

Abstract

Background: Previous studies have found various incidences of right ventricular (RV) injury and its association with clinical outcome in patients with acute respiratory distress syndrome (ARDS). In this systematic review and meta-analysis, we aimed to investigate the impact of the presence of RV injury on mortality in patients with ARDS. Method: We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies investigating the association between RV injury and mortality. Two authors independently evaluated whether studies meet eligibility criteria and extracted the selected patients’ and studies’ characteristics and outcomes. RV injury was diagnosed by trans-thoracic echocardiogram (TTE), trans-esophageal echocardiogram (TEE) and PAC (pulmonary artery catheter) in the included studies. The primary outcome was the association between mortality and the presence of RV injury in patients with ARDS. The overall reported mortality was defined as either the intensive care unit (ICU) mortality, in-hospital mortality, or mortality within 90 days, and short-term mortality was defined as ICU-mortality, in-hospital mortality, or mortality within 30 days. Results: We included 9 studies (N = 1861 patients) in this meta-analysis. RV injury that included RV dysfunction, RV dysfunction with hemodynamic compromise, RV failure, or acute cor-pulmonale was present in 21.0% (391/1,861). In the pooled meta-analysis, the presence of RV injury in patients with ARDS was associated with significantly higher overall mortality (OR 1.45, 95% CI 1.13–1.86, p-value = 0.003, I2 = 0%), as well as short-term mortality (OR 1.48, 95% CI 1.14–1.93, p-value = 0.003, I2 = 0%). Conclusion: In this systematic review and meta-analysis including 1861 patients with ARDS, the presence of RV injury was significantly associated with increased overall and short-term mortality. Trial registration: The protocol was registered at PROSPERO (CRD42020206521). [Figure not available: see fulltext.]