Right ventricular dysfunction is a frequent finding in patients under mechanical ventilation for respiratory failure, associated with increased mortality and poorer clinical outcomes. It is unclear if the adjunctive use of pulmonary vasodilators offers additional benefit than other supportive measures. We aim to describe the clinical outcomes of patients with respiratory failure-associated RV dysfunction treated with aerosolized prostacyclins.
We performed a retrospective analysis of patients admitted to all ICUs at Oklahoma University Medical Center between 2015-2017 with a main diagnosis of hypoxemic respiratory failure requiring mechanical ventilation. For the purpose of analysis, patients were divided into 2 main groups, depending on evidence of RV dysfunction (defined by a qualitative 2D echocardiogram showing RV dilation and/or systolic impairment). Hemodynamic and gas-exchange data was analyzed as surrogates of treatment response to aerosolized prostacyclins.
A total of 139 patients were included in the analysis, of whom 95 received iloprost (68.35%) and 31 received epoprostenol (31%). There was evidence of RV dysfunction in 30 patients (30.93%), of whom 24 had isolated RV dysfunction (80%). Patients with RV dysfunction had higher SOFA and APACHE-II scores. They were also more likely to require vasopressors on admission, although this difference didn’t reach statistical significance (56.67% vs. 38.81%, p=0.1241). There were no major differences in BNP or ScvO2 levels, as well as fluid balance, degree of hypoxia or amount of PEEP. Patients with RV dysfunction were also less likely to show improvements in gas-exchange or hemodynamics with the use of aerosolized prostacyclins.
RV dysfunction in the setting of hypoxemic respiratory failure correlates with severity of illness, and is associated with an attenuated response to adjunctive therapies such as aerosolized prostacyclins. Further analysis is needed to identify echocardiographic markers for proper phenotyping of RV dysfunction in this group of patients