%0 Journal Article %T Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome. %T Hypercapnia and right ventricle during severe ARDS %+ INSERM U955, équipe 13 %+ Service de réanimation medico-chirurgicale [CHU Raymond-Poincaré] %+ Service d'anesthésie-réanimation SAMU94-SMUR94 [Mondor] %A Mekontso Dessap, Armand %A Charron, Cyril %A Devaquet, Jérôme %A Aboab, Jérôme %A Jardin, François %A Brochard, Laurent, J. %A Vieillard-Baron, Antoine %Z This study was funded by the nonprofit public organization Assistance Publique-Hôpitaux de Paris. %Z The original publication is available at www.springerlink.com %< avec comité de lecture %J Intensive Care Med %V 35 %N 11 %P 1850-8 %8 2009-11 %D 2009 %R 10.1007/s00134-009-1569-2 %M 19652953 %K lung injury %K acidosis %K right heart %K alveolar recruitment %K alveolar dead space %Z Life Sciences [q-bio]/Biochemistry, Molecular BiologyJournal articles %X PURPOSE: To evaluate the effects of acute hypercapnia induced by positive end-expiratory pressure (PEEP) variations at constant plateau pressure (P (plat)) in patients with severe acute respiratory distress syndrome (ARDS) on right ventricular (RV) function. METHODS: Prospective observational study in two academic intensive care units enrolling 11 adults with severe ARDS (PaO(2)/FiO(2) <150 mmHg at PEEP >5 cmH(2)O). We compared three ventilatory strategies, each used for 1 h, with P (plat) at 22 (20-25) cmH(2)O: low PEEP (5.4 cmH(2)O) or high PEEP (11.0 cmH(2)O) with compensation of the tidal volume reduction by either a high respiratory rate (high PEEP/high rate) or instrumental dead space decrease (high PEEP/low rate). We assessed RV function (transesophageal echocardiography), alveolar dead space (expired CO(2)), and alveolar recruitment (pressure-volume curves). RESULTS: Compared to low PEEP, PaO(2)/FiO(2) ratio and alveolar recruitment were increased with high PEEP. Alveolar dead space remained unchanged. Both high-PEEP strategies induced higher PaCO(2) levels [71 (60-94) and 75 (53-84), vs. 52 (43-68) mmHg] and lower pH values [7.17 (7.12-7.23) and 7.20 (7.16-7.25) vs. 7.30 (7.24-7.35)], as well as RV dilatation, LV deformation and a significant decrease in cardiac index. The decrease in stroke index tended to be negatively correlated to the increase in alveolar recruitment with high PEEP. CONCLUSIONS: Acidosis and hypercapnia induced by tidal volume reduction and increase in PEEP at constant P (plat) were associated with impaired RV function and hemodynamics despite positive effects on oxygenation and alveolar recruitment ( ClinicalTrials.gov #NCT00236262). %G English %2 https://inserm.hal.science/inserm-00429687/document %2 https://inserm.hal.science/inserm-00429687/file/inserm-00429687_edited.pdf %2 https://inserm.hal.science/inserm-00429687/file/r2.pdf %L inserm-00429687 %U https://inserm.hal.science/inserm-00429687 %~ INSERM %~ APHP %~ IMRB %~ UPEC %~ PARTENARIATS-APP