Mortality of right ventricular dysfunction in patients with acute respiratory distress syndrome subjected to lung protective ventilation: A systematic review and meta-analysis.

The review pooled observational studies, so it cannot prove that right ventricular dysfunction caused death. Some included studies had baseline differences in age and SOFA score, which may have made the groups less comparable. The studies used different definitions of right ventricular dysfunction and different diagnostic methods, including echocardiography and pulmonary artery catheterization. Some studies had small samples or lower quality, which may have affected the pooled estimate. The subgroup with pulmonary vascular dysfunction or mild right ventricular dysfunction had a wide confidence interval, so the lack of association is uncertain. All patients were receiving lung-protective ventilation, so the results may not apply to ARDS patients managed with other ventilation strategies. The review did not test whether right ventricular monitoring, prone positioning, nitric oxide, or other treatments changed mortality.

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Do not read the higher odds of death as proof that treating right ventricular dysfunction will reduce mortality. The included studies were observational, and the subgroup with pulmonary vascular dysfunction or mild right ventricular dysfunction did not show an association.