Echocardiographic detection of transpulmonary bubble transit during acute respiratory distress syndrome

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• 作者：Florence Boissier (1) (2) (3)
  Keyvan Razazi (1)
  Arnaud W Thille (1) (4)
  Ferran Roche-Campo (1) (5)
  Rusel Leon (1) (6)
  Emmanuel Vivier (1) (7)
  Laurent Brochard (8)
  Christian Brun-Buisson (1) (2) (3)
  Armand Mekontso Dessap (1) (2) (3)
  
  1. AP-HP ; H么pital Henri Mondor ; DHU A-TVB ; Service de R茅animation M茅dicale ; Groupe de recherche CARMAS ; 51 Av Mal de Lattre de Tassigny ; Cr茅teil ; 94010 ; France
  2. INSERM ; Unit茅 U955 (IMRB) ; 8 rue du G茅n茅ral Sarrail ; Cr茅teil ; 94010 ; France
  3. Facult茅 de M茅decine ; Universit茅 Paris Est Cr茅teil ; 8 ; rue du G茅n茅ral Sarrail ; Cr茅teil ; 94010 ; France
  4. CHU de Poitiers ; R茅animation m茅dicale ; Poitiers ; France ; INSERM CIC 1402 (茅quipe 5 ALIVE) ; Universit茅 de Poitiers ; 2 Rue de la Mil茅trie ; 86021 ; Poitiers ; France
  5. Servei de Medicina Intensiva ; Hospital Verge de la Cinta ; Carrer de les Esplanetes ; 14 ; 43500 ; Tortosa ; Tarragona ; Spain
  6. Centre Hospitalier Intercommunal de Cr茅teil ; R茅animation polyvalente ; 40 avenue de Verdun ; 94010 ; Cr茅teil ; France
  7. Centre Hospitalier Saint Luc Saint Joseph ; R茅animation Polyvalente ; 20 ; quai Claude Bernard ; 69007 ; Lyon ; France
  8. Saint Michael鈥檚 Hospital ; 30 Bond Street ; ON ; M5B 1 W8 ; Toronto ; Canada
  
• 关键词：Echocardiography ; Acute respiratory distress syndrome ; Shunt
• 刊名：Annals of Intensive Care
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：5
• 期：1
• 全文大小：393 KB
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• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine; Anesthesiology;
• 出版者：Springer Paris
• ISSN：2110-5820

文摘

Background Transpulmonary bubble transit (TPBT) detected with contrast echocardiography is reported as a sign of intrapulmonary shunt during cirrhosis or exercise in healthy humans. However, its physiological meaning is not clear during acute respiratory distress syndrome (ARDS). Our aim was to determine the prevalence, significance, and prognosis of TPBT detection during ARDS. Methods This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and sixteen consecutive patients with moderate-to-severe ARDS underwent transesophageal echocardiography with modified gelatine contrast. Moderate-to-large TPBT was defined as right-to-left passage of at least ten bubbles through a pulmonary vein more than three cardiac cycles after complete opacification of the right atrium. Patients with intra-cardiac shunt through patent foramen ovale were excluded. Results The prevalence of moderate-to-large TPBT was 26% (including 42 patients with moderate and 15 with large TPBT). Patients with moderate-to-large TPBT had higher values of cardiac index and heart rate as compared to those without TPBT. There was no significant difference in PaO2/FIO2 ratio between groups, and TPBT was not influenced by end-expiratory positive pressure level in 93% of tested patients. Prevalence of septic shock was higher in the group with moderate-to-large TPBT. Patients with moderate-to-large TPBT had fewer ventilator-free days and intensive care unit-free days within the first 28 days, and higher in-hospital mortality as compared to others. Conclusions Moderate-to-large TPBT was detected with contrast echocardiography in 26% of patients with ARDS. This finding was associated with a hyperdynamic and septic state, but did not influence oxygenation.