Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Lece Webb; Luke Burton; Ananya Manchikalapati; Priya Prabhakaran; Jeremy M Loberger; Robert P Richter

doi:10.3389/fmed.2023.1216538

Cardiac dysfunction in severe pediatric acute respiratory distress syndrome: the right ventricle in search of the right therapy

Front Med (Lausanne). 2023 Aug 16:10:1216538. doi: 10.3389/fmed.2023.1216538. eCollection 2023.

Authors

Lece Webb¹, Luke Burton¹, Ananya Manchikalapati², Priya Prabhakaran¹, Jeremy M Loberger¹, Robert P Richter¹

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States.
² Division of Pediatric Critical Care, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States.

Abstract

Severe acute respiratory distress syndrome in children, or PARDS, carries a high risk of morbidity and mortality that is not fully explained by PARDS severity alone. Right ventricular (RV) dysfunction can be an insidious and often under-recognized complication of severe PARDS that may contribute to its untoward outcomes. Indeed, recent evidence suggest significantly worse outcomes in children who develop RV failure in their course of PARDS. However, in this narrative review, we highlight the dearth of evidence regarding the incidence of and risk factors for PARDS-associated RV dysfunction. While we wish to draw attention to the absence of available evidence that would inform recommendations around surveillance and treatment of RV dysfunction during severe PARDS, we leverage available evidence to glean insights into potentially helpful surveillance strategies and therapeutic approaches.

Keywords: children; echocardiography (Echo); extracorporeal membrane oxygenation (ECMO); pediatric acute respiratory distress syndrome (PARDS); right ventricular (RV) dysfunction.

Publication types

Review