Acute respiratory distress syndrome, mechanical ventilation and right ventricular function

Mechanical ventilation in acute respiratory distress syndrome (ARDS) implies an increase in alveolar and transpulmonary pressure, giving rise to major alterations in pulmonary circulation and causing right ventricular functional overload that can lead to ventricular failure and thus to acute cor pulmonale. The condition is echocardiographically characterized by dilatation of the right ventricle and paradoxical movement of the interventricular septum, with the added alteration of left ventricular systolic function. It is important to take lung mechanical and hemodynamic monitoring into account when defining the ventilation strategy in such patients, optimizing lung recruitment without producing pulmonary over-distension phenomena that may lead to greater deterioration of right ventricle function. This approach is known as a right ventricle protective ventilation strategy. (C) 2011 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.