Acute Cor Pulmonale and Ventilation In the critically ill,
Acute cor pulmonale (ACP) is usually observed in the setting of massive pulmonary embolism or acute respiratory distress syndrome (ARDS). As we manage more and more critically ill patients in the ED, it is likely that you will manage patients who develop ARDS.
We have discussed in previous pearls that, especially in ARDS, using a low tidal volume and monitoring plateau pressure are key components to mechanical ventilation.
For patients with ARDS who develop ACP, consider lower plateau pressure thresholds (< 26 cm H20) and minimizing PEEP to < 8 cm H2O.
If ACP persists despite lower plateau pressures and low PEEP, consider prone position ventilation as a last resort.
References
Jardin F, Vieilllard-Baron A. Acute cor pulmonale. Curr Opin Crit Care 2009;15:67-70.
