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Zhao H, Yan Y, Liu Y, Long L, Xue H, Zhao H. Bedside critical ultrasound as a key to the diagnosis of obstructive atelectasis complicated with acute cor pulmonale and differentiation from pulmonary embolism: A case report. J Clin Ultrasound 2022; 50:611-617. [PMID: 35285521 PMCID: PMC9310774 DOI: 10.1002/jcu.23190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Abstract
Acute attack of dyspnea may be combined with acute cor pulmonale (ACP). Rapid and accurate identification of the etiology of ACP is the key to its diagnosis and treatment. Echocardiography is a better imaging tool in the assessment of right ventricular function. Under the guidance of the theory of cardiopulmonary interaction, ultrasonography can detect lung lesions, which causes ACP. We report the case of a 67-year-old man who received mechanical ventilation for acute respiratory failure. Right ventricular dysfunction was detected by echocardiography. Lung ultrasound showed a high risk of pulmonary embolism. However, obstructive atelectasis should not be ruled out after increasing back area ultrasonography. To avoid pitfalls, combined cardiac and lung ultrasound should be used carefully and strictly.
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Affiliation(s)
- Haotian Zhao
- Department of UltrasoundHebei General HospitalShijiazhuangHebeiChina
| | - Yaru Yan
- Department of UltrasoundShijiazhuang People's HospitalShijiazhuangHebeiChina
| | - Yi Liu
- Department of UltrasoundHebei General HospitalShijiazhuangHebeiChina
| | - Ling Long
- Department of Intensive Care UnitHebei General HospitalShijiazhuangHebeiChina
| | - Hongyuan Xue
- Department of UltrasoundHebei General HospitalShijiazhuangHebeiChina
| | - Heling Zhao
- Department of Intensive Care UnitHebei General HospitalShijiazhuangHebeiChina
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Díaz JJS, Rincon JM, López MAR, Zuleta MB, Castellanos N, Saavedra ZS, Rodríguez HC, Barrera DFH, Parra JE, Fernández JJD. Echocardiographic 60-day mortality markers in patients hospitalized in intensive care for COVID-19. Heart Lung 2022; 52:123-129. [PMID: 35016107 PMCID: PMC8720561 DOI: 10.1016/j.hrtlng.2021.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/30/2021] [Accepted: 12/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Coronavirus disease COVID-19 produces a predominantly pulmonary affection, being cardiac involvement an important component of the multiorganic dysfunction. At the moment there are few reports about the behavior of echocardiographic images in the patients who have the severe forms of the disease. OBJECTIVE Identify the echocardiographic prognostic markers for death within 60 days in patients hospitalized in intensive care. METHODS A single-center prospective cohort was made with patients hospitalized in intensive care for COVID-19 confirmed via polymerase chain reaction who got an echocardiogram between May and October 2020. A Cox multivariate model was plotted reporting the HR and confidence intervals with their respective p values for clinical and echocardiographic variables. RESULTS Out of the 326 patients included, 153 patients got an echocardiogram performed on average 6.8 days after admission. The average age was 60.7, 47 patients (30.7%) were females and 67 (44.7%) registered positive troponin. 91 patients (59.5%) died. The univariate analysis identified TAPSE, LVEF, pulmonary artery systolic pressure, acute cor pulmonale, right ventricle diastolic dysfunction, and right ventricular dilatation as variables associated with mortality. The multivariate model identified that the acute cor pulmonale with HR= 4.05 (CI 95% 1.09 - 15.02, p 0.037), the right ventricular dilatation with HR= 3.33 (CI 95% 1.29 - 8.61, p 0.013), and LVEF with HR= 0.94 (CI 95% 0.89 - 0.99, p 0.020) were associated with mortality within 60 days. CONCLUSIONS In patients hospitalized in the intensive care unit for COVID-19, the LVEF, acute cor pulmonale and right ventricular dilatation are prognostic echocardiographic markers associated with death within 60 days.
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Affiliation(s)
- John Jaime Sprockel Díaz
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia; School of Medicine, Fundación Universitaria de Ciencias de la Salud, Internal Medicine Service Hospital de San José; Institute of Research. Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia.
| | - Juan Manuel Rincon
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Manuela Alejandra Rondón López
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Marisol Bejarano Zuleta
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Nathaly Castellanos
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Zulima Santofimio Saavedra
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Hellen Cárdenas Rodríguez
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Diego Felipe Hernandez Barrera
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Jhon Edison Parra
- Department of Intensive Care Health Services Unit Hospital El Tunal, Integrated Health Subnet of the South, Bogotá, Colombia
| | - Juan José Diaztagle Fernández
- School of Medicine, Fundación Universitaria de Ciencias de la Salud, Internal Medicine Service Hospital de San José; Department of Physiological Sciences, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
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Beyls C, Bohbot Y, Huette P, Booz T, Daumin C, Abou-Arab O, Mahjoub Y. Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19. J Cardiothorac Vasc Anesth 2021; 35:3594-3603. [PMID: 33558133 PMCID: PMC7832272 DOI: 10.1053/j.jvca.2021.01.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 01/02/2023]
Abstract
Objective To compare two-dimensional–speckle tracking echocardiographic parameters (2D-STE) and classic echocardiographic parameters of right ventricular (RV) systolic function in patients with coronavirus disease 2019 (COVID-19)–related acute respiratory distress syndrome (CARDS) complicated or not by acute cor pulmonale (ACP). Design Prospective, between March 1, 2020 and April 15, 2020. Setting Intensive care unit of Amiens University Hospital (France). Participants Adult patients with moderate-to-severe CARDS under mechanical ventilation for fewer than 24 hours. Interventions None. Measurements and Main Results Tricuspid annular displacement (TAD) parameters (TAD-septal, TAD-lateral, and RV longitudinal shortening fraction [RV-LSF]), RV global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RVFWLS) were measured using transesophageal echocardiography with a dedicated software and compared with classic RV systolic parameters (RV-FAC, S′ wave, and tricuspid annular plane systolic excursion [TAPSE]). RV systolic dysfunction was defined as RV-FAC <35%. Twenty-nine consecutive patients with moderate-to-severe CARDS were included. ACP was diagnosed in 12 patients (41%). 2D-STE parameters were markedly altered in the ACP group, and no significant difference was found between patients with and without ACP for classic RV parameters (RV-FAC, S′ wave, and TAPSE). In the ACP group, RV-LSF (17% [14%-22%]) had the best correlation with RV-FAC (r = 0.79, p < 0.001 v r = 0.27, p = 0.39 for RVGLS and r = 0.28, p = 0.39 for RVFWLS). A RV-LSF cut-off value of 17% had a sensitivity of 80% and a specificity of 86% to identify RV systolic dysfunction. Conclusions Classic RV function parameters were not altered by ACP in patients with CARDS, contrary to 2D-STE parameters. RV-LSF seems to be a valuable parameter to detect early RV systolic dysfunction in CARDS patients with ACP.
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Affiliation(s)
- Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Thomas Booz
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Camille Daumin
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
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Huette P, Beyls C, Guilbart M, Haye G, Najid FZ, Mestan B, Roger PA, Dupont H, Abou-Arab O, Mahjoub Y. Acute Cor Pulmonale in COVID-19-Related ARDS: Improvement With Almitrine Infusion. JACC Case Rep 2020; 2:1311-1314. [PMID: 32835274 PMCID: PMC7296301 DOI: 10.1016/j.jaccas.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022]
Abstract
Coronavirus disease-19 (COVID-19)-related severe acute respiratory distress syndrome can lead to acute cor pulmonale. We report a case of acute cor pulmonale secondary to severe COVID-19 acute respiratory distress syndrome diagnosed with transesophageal echocardiography. Almitrine infusion allowed rapid enhancement of right ventricular function as well as improvement in oxygenation. (Level of Difficulty: Intermediate.)
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Key Words
- ACE2, angiotensin-converting enzyme 2
- ACP, acute cor pulmonale
- ARDS
- ARDS, acute respiratory distress syndrome
- CI, cardiac index
- COVID-19
- COVID-19, coronavirus disease-19
- CT, computed tomography
- Fio2, fraction of inspired oxygen
- Pao2, partial pressure of oxygen
- RV, right ventricle
- RVSWI, right ventricular stroke work index
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- TEE, transesophageal echocardiography
- acute cor pulmonale
- almitrine
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Affiliation(s)
- Pierre Huette
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Christophe Beyls
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Mathieu Guilbart
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Guillaume Haye
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Fatim-Zahra Najid
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Benjamin Mestan
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Pierre-Alexandre Roger
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Hervé Dupont
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Osama Abou-Arab
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
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Su LX, Shang XL, Zhu R, He W, Pan P, Zhang HM, Zhang LN, Liu DW, Yu RG, Wang XT. A cross-sectional study of acute cor pulmonale in acute respiratory distress syndrome patients in China. Chin Med J (Engl) 2019; 132:2842-2847. [PMID: 31856056 PMCID: PMC6940069 DOI: 10.1097/cm9.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Increased right ventricle afterload during acute respiratory distress syndrome (ARDS) may induce acute cor pulmonale (ACP), which is associated with a poor clinical outcome. Echocardiography is now considered as a rapid and non-invasive tool for diagnosis of ACP. The aims of this study were to investigate the morbidity and mortality rates of ACP in ARDS patients in intensive care units (ICUs) across the mainland of China and to determine the severity and prognosis of ACP in ARDS patients through an ultrasound protocol (TRIP). And the association between ACP related factors and the ICU mortality will be revealed. METHODS This study is a multicenter and cross-sectional study in China which will include ICU participants when diagnosed as ARDS. The ultrasound protocol, known as the TRIP, is proposed as severity assessment for ACP, which includes tricuspid regurgitation velocity (T), right ventricular size (R), inferior vena cava diameter fluctuation (I), and pulmonary regurgitation velocity (P). The 28-day mortality, ICU/hospital mortality, the length of stay in ICU, mechanical ventilation days, hemodynamic parameters and lab parameters of liver function and kidney function are all recorded. DISCUSSION This large-scale study would give a sufficient epidemic investigation of ACP in ARDS patients in China. In addition, with the TRIP protocol, we expect that we could stratify ACP with more echocardiography parameters. TRIAL REGISTRATION NCT03827863, https://clinicaltrials.gov/ct2/show/NCT03827863.
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Affiliation(s)
- Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiu-Ling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Ran Zhu
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Wei He
- Department of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Pan Pan
- Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China
| | - Hong-Min Zhang
- Department of Critical Care Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Li-Na Zhang
- Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Rong-Guo Yu
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
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6
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Barnes T, Zochios V, Parhar K. Re-examining Permissive Hypercapnia in ARDS: A Narrative Review. Chest 2017; 154:185-195. [PMID: 29175086 DOI: 10.1016/j.chest.2017.11.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022] Open
Abstract
Lung-protective ventilation (LPV) has become the cornerstone of management in patients with ARDS. A subset of patients is unable to tolerate LPV without significant CO2 elevation. In these patients, permissive hypercapnia is used. Although thought to be benign, it is becoming increasingly evident that elevated CO2 levels have significant physiological effects. In this narrative review, we highlight clinically relevant end-organ effects in both animal models and clinical studies. We also explore the association between elevated CO2, acute cor pulmonale, and ICU mortality. We conclude with a brief review of alternative therapies for CO2 management currently under investigation in patients with moderate to severe ARDS.
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Affiliation(s)
- Tavish Barnes
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Vasileios Zochios
- Department of Critical Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England
| | - Ken Parhar
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
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7
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Abstract
Pulmonary vascular dysfunction is associated with ARDS and leads to increased right-ventricular afterload and eventually right-ventricular failure, also called acute cor pulmonale. Interest in acute cor pulmonale and its negative impact on outcome in patients with ARDS has grown in recent years. Right-ventricular function in these patients should be closely monitored, and this is helped by the widespread use of echocardiography in intensive care units. Because mechanical ventilation may worsen right-ventricular failure, the interaction between the lungs and the right ventricle appears to be a key factor in the ventilation strategy. In this review, a rationale for a right ventricle-protective ventilation approach is provided, and such a strategy is described, including the reduction of lung stress (ie, the limitation of plateau pressure and driving pressure), the reduction of PaCO2 , and the improvement of oxygenation. Prone positioning seems to be a crucial part of this strategy by protecting both the lungs and the right ventricle, resulting in increased survival of patients with ARDS. Further studies are required to validate the positive impact on prognosis of right ventricle-protective mechanical ventilation.
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Affiliation(s)
- Alexis Paternot
- Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France. Faculty of Medicine, University of Versailles Saint-Quentin en Yvelines, Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France
| | - Xavier Repessé
- Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France
| | - Antoine Vieillard-Baron
- Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Boulogne-Billancourt, France. Faculty of Medicine, University of Versailles Saint-Quentin en Yvelines, Paris Ile-de-France Ouest, Saint-Quentin en Yvelines, France. INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, Villejuif, France.
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8
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Lai PS, Mita C, Thompson BT. What is the clinical significance of pulmonary hypertension in acute respiratory distress syndrome? A review. Minerva Anestesiol 2014; 80:574-585. [PMID: 24193181 PMCID: PMC4036117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Elevated pulmonary arterial pressures appear to be a prominent feature of the acute respiratory distress syndrome (ARDS). Current clinical guidelines for the management of ARDS do not specifically address treatment of pulmonary hypertension or associated right ventricular dysfunction because the clinical significance of this entity remains unclear. Interpretation of elevated pulmonary arterial pressures, pulmonary vascular resistance, and transpulmonary gradient as well as signs of right ventricular dysfunction is confounded by the effects of positive pressure ventilation. There does not appear to be a consistent relationship between the diagnosis of pulmonary hypertension or right ventricular failure and mortality in patients with ARDS, but it is unclear if right ventricular failure contributes to the mortality risk per se or if the underlying cause of pulmonary hypertension, including intravascular micro and macro thrombosis, are simply markers for systemic dysregulation of coagulation and fibrinolysis that may lead to multiorgan failure in ARDS. While studies of pulmonary vasodilator therapies have not shown a mortality benefit in ARDS, such trials have targeted improved oxygenation rather than improved pulmonary hemodynamics so that the possible contribution of improved right ventricular function to better outcomes has not been directly tested in large trials. Future studies are needed to determine if treatment of pulmonary hypertension and associated right ventricular dysfunction will affect mortality in patients with ARDS.
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Affiliation(s)
- P S Lai
- Pulmonary and Critical Care Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA -
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9
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Aguirre-Avalos G, Covarrubias-Velasco MA, Rojas-Sánchez AG. Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation. Am J Case Rep 2013; 14:354-8. [PMID: 24046802 PMCID: PMC3775614 DOI: 10.12659/ajcr.889261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 05/16/2013] [Indexed: 12/12/2022]
Abstract
Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine
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Affiliation(s)
- Guadalupe Aguirre-Avalos
- Intensive Care Unit, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara Jalisco, México ; Investigación en Microbiología Médica, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara Jalisco, México
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Abstract
The acute respiratory distress syndrome (ARDS) is a complex disorder of heterogeneous etiologies characterized by a consistent, recognizable pattern of lung injury. Extensive epidemiologic studies and clinical intervention trials have been conducted to address the high mortality of this disorder and have provided significant insight into the complexity of studying new therapies for this condition. The existing clinical investigations in ARDS will be highlighted in this review. The limitations to current definitions, patient selection, and outcome assessment will be considered. While significant attention has been focused on the parenchymal injury that characterizes this disorder and the clinical support of gas exchange function, relatively limited focus has been directed to hemodynamic and pulmonary vascular dysfunction equally prominent in the disease. The limited available clinical information in this area will also be reviewed. The current standards for cardiopulmonary management of the condition will be outlined. Current gaps in our understanding of the clinical condition will be highlighted with the expectation that continued progress will contribute to a decline in disease mortality.
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Affiliation(s)
- Michael Donahoe
- Department of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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11
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Abstract
Pulmonary artery pressure elevation complicates the course of many complex disorders treated in a noncardiac intensive care unit. Acute pulmonary hypertension, however, remains underdiagnosed and its treatment frequently begins only after serious complications have developed. Significant pathophysiologic differences between acute and chronic pulmonary hypertension make current classification and treatment recommendations for chronic pulmonary hypertension barely applicable to acute pulmonary hypertension. In order to clarify the terminology of acute pulmonary hypertension and distinguish it from chronic pulmonary hypertension, we provide a classification of acute pulmonary hypertension according to underlying pathophysiologic mechanisms, clinical features, natural history, and response to treatment. Based on available data, therapy of acute arterial pulmonary hypertension should generally be aimed at acutely relieving right ventricular (RV) pressure overload and preventing RV dysfunction. Cases of severe acute pulmonary hypertension complicated by RV failure and systemic arterial hypotension are real clinical challenges requiring tight hemodynamic monitoring and aggressive treatment including combinations of pulmonary vasodilators, inotropic agents and systemic arterial vasoconstrictors. The choice of vasopressor and inotropes in patients with acute pulmonary hypertension should take into consideration their effects on vascular resistance and cardiac output when used alone or in combinations with other agents, and must be individualized based on patient response.
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Affiliation(s)
- Mykola V Tsapenko
- Division of Pulmonary and Critical Care Medicine, Mayo Epidemiology and Translational Research in Intensive Care, Mayo Clinic, Rochester, MN 55905, USA.
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