RESPIRATORY SYSTEM: Edited by Marco RanieriAcute respiratory distress syndrome the heart side of the moonRepessé, Xavier; Charron, Cyril; Vieillard-Baron, AntoineAuthor Information aAssistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism bUniversity of Versailles Saint-Quentin en Yvelines, Faculty of Medicine Paris Ile-de-France Ouest cINSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Paris, France Correspondence to Prof. Antoine Vieillard-Baron, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, University Hospital Ambroise Paré, 9, avenue Charles-de-Gaulle 92100 Boulogne-Billancourt, Paris, France. Tel: +33149095603; fax: +33149095892; e-mail: [email protected] Current Opinion in Critical Care: February 2016 - Volume 22 - Issue 1 - p 38-44 doi: 10.1097/MCC.0000000000000267 Buy Metrics Abstract Purpose of review Circulatory failure is a frequent complication during acute respiratory distress syndrome (ARDS) and is associated with a poor outcome. This review aims at clarifying the mechanisms of circulatory failure during ARDS. Recent findings For the past decades, the right ventricle (RV) has gained a crucial interest since many authors confirmed the high incidence of acute cor pulmonale during ARDS and showed a potential role of the acute cor pulmonale in the poor outcome of ARDS patients. The most important recent progress demonstrated in ARDS ventilatory strategy is represented by the prone position, which has a huge beneficial effect on RV afterload. This review will focus on the mechanisms responsible for the RV dysfunction/failure during ARDS and on the strategy, which allows improving the right ventricular function. Summary The RV has a pivotal role in the circulatory failure of ARDS patients. The ventilatory strategy during ARDS has to pay a peculiar attention to the RV to rigorously control its afterload. Copyright © 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.