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**Chapter 6**

**Abstract**

Application of Thoracic

Ultrasonography for Acute Cor

Pulmonale in Acute Respiratory

Beneficial therapeutic interventions for acute respiratory distress syndrome (ARDS) include lung protective ventilation; however, ventilator may cause or sometimes worsen acute cor pulmonale (ACP) induced by pulmonary gas exchange disorder and pulmonary vascular dysfunction due to ARDS. The incidence of ACP was 22–50% in mechanically ventilated patients. Currently, point-of-care ultrasound has been widely used in ARDS patients, which becomes much more important in the early detection and management of ARDS and its complications. Application of lung ultrasound combined with echocardiography could monitor respiratory status, hemodynamics, and cardiac function and optimize the ventilation setting in order to protect both lung and right ventricle. This chapter will discuss the pathophysiology of ACP associated with ARDS and the use of point-of-care ultrasound to make

**Keywords:** acute respiratory distress syndrome, acute cor pulmonale, point-of-care

The concept of acute respiratory distress syndrome (ARDS) was first described

about five decades ago [1], which is characterized by the acute development of hypoxemia accompanied with bilateral lung infiltrates [2]. ARDS is responsible not only for infections, shock, and multiple organ dysfunction syndromes but also for acute cor pulmonale (ACP) and right ventricular failure in critical ill patients. The mortality of ARDS is 40% approximately in intensive care unit [3], and almost 25% of mechanically ventilated patients could be affected by ARDS [4]. Lung protective mechanical ventilation using low tidal volume and high positive end expiratory pressure (PEEP) and other therapeutic interventions such as fluid restrictive, prone position, neuromuscular blockade, lung recruitment, and sometimes venovenous extracorporeal membrane oxygenation (VV ECMO) for severe cases may be beneficial [5–9]; however, none of them are promising and may cause other complications, for instance, low tidal volume and high PEEP may lead to hypercapnia and

Distress Syndrome Patients

protective strategies for lung and right ventricle in detail.

*You Shang and Ting Zhou*

ultrasound, organ protection

consecutive right heart failure [4].

**1. Introduction**

## **Chapter 6**
