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World J Crit Care Med. Mar 9, 2021; 10(2): 35-42
Published online Mar 9, 2021. doi: 10.5492/wjccm.v10.i2.35
Acute cor pulmonale in patients with acute respiratory distress syndrome: A comprehensive review
Kay Choong See
Kay Choong See, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: See KC collected the data and wrote the paper; See KC read and approved the final manuscript.
Conflict-of-interest statement: See KC declares no relevant conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kay Choong See, FCCP, FRCP, MBBS, MRCP, Doctor, Department of Medicine, National University Hospital, 1E Kent Ridge Rd, NUHS Tower Block Level 10, Singapore 119228, Singapore. kay_choong_see@nuhs.edu.sg
Received: December 6, 2020
Peer-review started: December 6, 2020
First decision: December 31, 2020
Revised: January 1, 2020
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: March 9, 2021
Core Tip

Core Tip: Acute respiratory distress syndrome (ARDS)-related acute cor pulmonale (ACP) is associated with adverse hemodynamic and survival outcomes. It is an echocardiographic diagnosis marked by combined right ventricular dilatation and septal dyskinesia. Checking for ARDS-related ACP should be done in patients with ≥ 2 of 4 risk factors: Pneumonia, arterial partial pressure of oxygen-to-inspired oxygen fraction ratio < 150 mmHg, arterial partial pressure of carbon dioxide ≥ 48 mmHg, and driving pressure ≥ 18 cmH2O. Treatments include ventilator adjustment (aiming for arterial partial pressure of carbon dioxide < 60 mmHg, plateau pressure < 27 cmH2O, driving pressure < 17 cmH2O), prone positioning, fluid balance optimization and pharmacotherapy.