See Kay Choong
Department of Medicine, National University Hospital, Singapore 119228, Singapore.
World J Crit Care Med. 2021 Mar 9;10(2):35-42. doi: 10.5492/wjccm.v10.i2.35.
Acute respiratory distress syndrome (ARDS)-related acute cor pulmonale (ACP) is found in 8%-50% of all patients with ARDS, and is associated with adverse hemodynamic and survival outcomes. ARDS-related ACP is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia, which connote simultaneous diastolic (volume) and systolic (pressure) overload respectively. Risk factors include pneumonia, hypercapnia, hypoxemia, high airway pressures and concomitant pulmonary disease. Current evidence suggests that ARDS-related ACP is amenable to multimodal treatments including ventilator adjustment (aiming for arterial partial pressure of carbon dioxide < 60 mmHg, plateau pressure < 27 cmHO, driving pressure < 17 cmHO), prone positioning, fluid balance optimization and pharmacotherapy. Further research is required to elucidate the optimal frequency and duration of routine bedside echocardiography screening for ARDS-related ACP, to more clearly delineate the diagnostic role of transthoracic echocardiography relative to transesophageal echocardiography, and to validate current and novel therapies.
在所有急性呼吸窘迫综合征（ARDS）患者中，8%-50%会出现与ARDS相关的急性肺心病（ACP），且其与不良的血流动力学和生存结局相关。与ARDS相关的ACP是一种超声心动图诊断，其特征为右心室扩张和室间隔运动障碍同时出现，分别意味着舒张期（容量）和收缩期（压力）负荷过重。危险因素包括肺炎、高碳酸血症、低氧血症、高气道压力和合并的肺部疾病。目前的证据表明，与ARDS相关的ACP适合多种治疗方法，包括调整呼吸机（目标是动脉血二氧化碳分压<60 mmHg、平台压<27 cmH₂O、驱动压<17 cmH₂O）、俯卧位、优化液体平衡和药物治疗。需要进一步研究以阐明针对与ARDS相关的ACP进行常规床边超声心动图筛查的最佳频率和持续时间，更清晰地界定经胸超声心动图相对于经食管超声心动图的诊断作用，并验证现有和新的治疗方法。
