1
|
Povlsen AL, Helgestad OKL, Josiassen J, Christensen S, Højgaard HF, Kjærgaard J, Hassager C, Schmidt H, Jensen LO, Holmvang L, Møller JE, Ravn HB. Invasive mechanical ventilation in cardiogenic shock complicating acute myocardial infarction: A contemporary Danish cohort analysis. Int J Cardiol 2024; 405:131910. [PMID: 38423479 DOI: 10.1016/j.ijcard.2024.131910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Invasive mechanical ventilation (IMV) is widely used in patients with cardiogenic shock following acute myocardial infarction (AMICS), but evidence to guide practice remains sparse. We sought to evaluate trends in the rate of IMV utilization, applied settings, and short term-outcome of a contemporary cohort of AMICS patients treated with IMV according to out-of-hospital cardiac arrest (OHCA) at admission. METHODS Consecutive AMICS patients receiving IMV in an intensive care unit (ICU) at two tertiary centres between 2010 and 2017. Data were analysed in relation to OHCA. RESULTS A total of 1274 mechanically ventilated AMICS patients were identified, 682 (54%) with OHCA. Frequency of IMV increased during the study period, primarily due to higher occurrence of OHCA admissions. Among 566 patients with complete ventilator data, positive-end-expiratory pressure, inspired oxygen fraction, and minute ventilation during the initial 24 h in ICU were monitored. No differences were observed between 30-day survivors and non-survivors with OHCA. In non-OHCA, these ventilator requirements were significantly higher among 30-day non-survivors (P for all<0.05), accompanied by a lower PaO2/FiO2 ratio (median 143 vs. 230, P < 0.001) and higher arterial lactate levels (median 3.5 vs. 1.5 mmol/L, P < 0.001) than survivors. Physiologically normal PaO2 and pCO2 levels were achieved in all patients irrespective of 30-day survival and OHCA status. CONCLUSION In the present contemporary cohort of AMICS patients, physiologically normal blood gas values were achieved both in OHCA and non-OHCA in the early phase of admission. However, increased demand of ventilatory support was associated with poorer survival only in non-OHCA patients.
Collapse
Affiliation(s)
- Amalie Ling Povlsen
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Ole Kristian Lerche Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Frederiksen Højgaard
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Lisette Okkels Jensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| | - Hanne Berg Ravn
- Department of Cardiothoracic Anaesthesia, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic Anaesthesia, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Southern Denmark, Denmark
| |
Collapse
|
2
|
Lopez MP, Applefeld W, Miller PE, Elliott A, Bennett C, Lee B, Barnett C, Solomon MA, Corradi F, Sionis A, Mireles-Cabodevila E, Tavazzi G, Alviar CL. Complex Heart-Lung Ventilator Emergencies in the CICU. Cardiol Clin 2024; 42:253-271. [PMID: 38631793 DOI: 10.1016/j.ccl.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
This review aims to enhance the comprehension and management of cardiopulmonary interactions in critically ill patients with cardiovascular disease undergoing mechanical ventilation. Highlighting the significance of maintaining a delicate balance, this article emphasizes the crucial role of adjusting ventilation parameters based on both invasive and noninvasive monitoring. It provides recommendations for the induction and liberation from mechanical ventilation. Special attention is given to the identification of auto-PEEP (positive end-expiratory pressure) and other situations that may impact hemodynamics and patients' outcomes.
Collapse
Affiliation(s)
- Mireia Padilla Lopez
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Willard Applefeld
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - P. Elliott Miller
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrea Elliott
- Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Courtney Bennett
- Heart and Vascular Institute, Leigh Valley Health Network, Allentown, PA, USA
| | - Burton Lee
- Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MA, USA
| | - Christopher Barnett
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Solomon
- Clinical Center and Cardiology Branch, Critical Care Medicine Department, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MA, USA
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Sionis
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduardo Mireles-Cabodevila
- Respiratory Institute, Cleveland Clinic, Ohio and the Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Guido Tavazzi
- Department of Critical Care Medicine, Intensive Care Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlos L Alviar
- The Leon H. Charney Division of Cardiovascular Medicine, New York University School of Medicine, USA.
| |
Collapse
|
3
|
Dager WE. Developing precision-based multidisciplinary pharmacotherapy management plans in the critically ill. Pharmacotherapy 2023; 43:1102-1111. [PMID: 37772645 DOI: 10.1002/phar.2871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/16/2023] [Accepted: 07/27/2023] [Indexed: 09/30/2023]
Affiliation(s)
- William E Dager
- Davis Medical Center, University of California, Sacramento, California, USA
- University of California San Francisco School of Pharmacy, San Francisco, California, USA
- University of California Davis School of Medicine, Sacramento, California, USA
| |
Collapse
|
4
|
Relationship between Driving Pressure and Mortality in Ventilated Patients with Heart Failure: A Cohort Study. Can Respir J 2021; 2021:5574963. [PMID: 34880958 PMCID: PMC8648448 DOI: 10.1155/2021/5574963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 10/09/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Heart failure (HF) is a leading cause of mortality and morbidity worldwide, with an increasing incidence. Invasive ventilation is considered to be essential for patients with HF. Previous studies have shown that driving pressure is associated with mortality in acute respiratory distress syndrome (ARDS). However, the relationship between driving pressure and mortality has not yet been examined in ventilated patients with HF. We assessed the association of driving pressure and mortality in patients with HF. Methods We conducted a retrospective cohort study of invasive ventilated adult patients with HF from the Medical Information Mart for Intensive Care-III database. We used multivariable logistic regression models, a generalized additive model, and a two-piecewise linear regression model to show the effect of the average driving pressure within 24 h of intensive care unit admission on in-hospital mortality. Results Six hundred and thirty-two invasive ventilated patients with HF were enrolled. Driving pressure was independently associated with in-hospital mortality (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06–1.18; P < 0.001) after adjusted potential confounders. A nonlinear relationship was found between driving pressure and in-hospital mortality, which had a threshold around 14.27 cmH2O. The effect sizes and CIs below and above the threshold were 0.89 (0.75 to 1.05) and 1.17 (1.07 to 1.30), respectively. Conclusions There was a nonlinear relationship between driving pressure and mortality in patients with HF who were ventilated for more than 48 h, and this relationship was associated with increased in-hospital mortality when the driving pressure was more than 14.27 cmH2O.
Collapse
|
5
|
Yukino M, Nagatomo Y, Goda A, Kohno T, Takei M, Nishihata Y, Saji M, Toyosaki Y, Nakano S, Ikegami Y, Shiraishi Y, Kohsaka S, Adachi T, Yoshikawa T. Association of Non-Invasive Positive Pressure Ventilation with Short-Term Clinical Outcomes in Patients Hospitalized for Acute Decompensated Heart Failure. J Clin Med 2021; 10:jcm10215092. [PMID: 34768609 PMCID: PMC8584464 DOI: 10.3390/jcm10215092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/06/2023] Open
Abstract
The real-world evidence has been sparse on the impact of non-invasive positive pressure ventilation (NPPV) on the outcomes in acute decompensated heart failure (ADHF) patients. We aim to explore this issue in the prospective multicenter WET-HF registry. Among 3927 patients (77 (67–84) years, male 60%), the NPPV was used in 775 patients (19.7%). The association of NPPV use with in-hospital outcome and length of hospital stay (LOS) was examined by two methods, propensity score (PS) matching and multivariable analysis with adjustment for PS. In these analyses the NPPV group exhibited a lower endotracheal intubation (ETI) rate and a comparable in-hospital mortality, but longer LOS compared to the non-NPPV group. In the stratified analysis, the NPPV group exhibited a significantly lower ETI rate in patients with ischemic etiology, systolic blood pressure (sBP) > 140 mmHg and the Controlling Nutritional Status (CONUT) score ≤ 3, indicating better nutritional status. On the contrary, NPPV use was associated with longer LOS in patients with non-ischemic etiology, sBP < 100 mmHg and CONUT score > 3. In conclusion, NPPV use was associated with a lower incidence of ETI. Particularly, patients with ischemic etiology, high sBP, and better nutritional status might benefit from NPPV use.
Collapse
Affiliation(s)
- Midori Yukino
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
- Correspondence: ; Tel.: +81-4-2995-1597
| | - Ayumi Goda
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Takashi Kohno
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan; (A.G.); (T.K.)
| | - Makoto Takei
- Department of Cardiology, Saiseikai Central Hospital, Tokyo 108-0073, Japan;
| | - Yosuke Nishihata
- Department of Cardiology, St. Luke’s International Hospital, Tokyo 104-8560, Japan;
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (M.S.); (T.Y.)
| | - Yuichi Toyosaki
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (Y.T.); (S.N.)
| | - Shintaro Nakano
- Department of Cardiology, Saitama Medical University International Medical Center, Hidaka 350-1298, Japan; (Y.T.); (S.N.)
| | - Yukinori Ikegami
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
- Department of Cardiology, National Hospital Organization, Tokyo Medical Center, Tokyo 152-8902, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo 160-8582, Japan; (Y.S.); (S.K.)
| | - Shun Kohsaka
- Department of Cardiology, Kyorin University Faculty of Medicine, Tokyo 160-8582, Japan; (Y.S.); (S.K.)
| | - Takeshi Adachi
- Department of Cardiology, National Defense Medical College, Tokorozawa 359-8513, Japan; (M.Y.); (Y.I.); (T.A.)
| | - Tsutomu Yoshikawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan; (M.S.); (T.Y.)
| |
Collapse
|
6
|
Palanidurai S, Phua J, Chan YH, Mukhopadhyay A. P/FP ratio: incorporation of PEEP into the PaO 2/FiO 2 ratio for prognostication and classification of acute respiratory distress syndrome. Ann Intensive Care 2021; 11:124. [PMID: 34370116 PMCID: PMC8350287 DOI: 10.1186/s13613-021-00908-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background The current Berlin definition of acute respiratory distress syndrome (ARDS) uses the PaO2/FiO2 (P/F) ratio to classify severity. However, for the same P/F ratio, a patient on a higher positive end-expiratory pressure (PEEP) may have more severe lung injury than one on a lower PEEP. Objectives We designed a new formula, the P/FP ratio, incorporating PEEP into the P/F ratio and multiplying with a correction factor of 10 [(PaO2*10)/(FiO2*PEEP)], to evaluate if it better predicts hospital mortality compared to the P/F ratio post-intubation and to assess the resultant changes in severity classification of ARDS. Methods We categorized patients from a dataset of seven ARDS network trials using the thresholds of ≤ 100 (severe), 101–200 (moderate), and 201–300 (mild) for both P/F (mmHg) and P/FP (mmHg/cmH2O) ratios and evaluated hospital mortality using areas under the receiver operating characteristic curves (AUC). Results Out of 3,442 patients, 1,057 (30.7%) died. The AUC for mortality was higher for the P/FP ratio than the P/F ratio for PEEP levels > 5 cmH2O: 0.710 (95% CI 0.691–0.730) versus 0.659 (95% CI 0.637–0.681), P < 0.001. Improved AUC was seen with increasing PEEP levels; for PEEP ≥ 18 cmH2O: 0.963 (95% CI 0.947–0.978) versus 0.828 (95% CI 0.765–0.891), P < 0.001. When the P/FP ratio was used instead of the P/F ratio, 12.5% and 15% of patients with moderate and mild ARDS, respectively, were moved to more severe categories, while 13.9% and 33.6% of patients with severe and moderate ARDS, respectively, were moved to milder categories. The median PEEP and FiO2 were 14 cmH2O and 0.70 for patients reclassified to severe ARDS, and 5 cmH2O and 0.40 for patients reclassified to mild ARDS. Conclusions The multifactorial P/FP ratio has a greater predictive validity for hospital mortality in ARDS than the P/F ratio. Changes in severity classification with the P/FP ratio reflect both true illness severity and the applied PEEP strategy. Trial registration: ClinialTrials.gov–NCT03946150. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00908-3.
Collapse
Affiliation(s)
- Sunitha Palanidurai
- Intensive Care Unit, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore, 159964, Singapore.
| | - Jason Phua
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore.,Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amartya Mukhopadhyay
- FAST and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore, Singapore.,Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Medical Affairs, Alexandra Hospital, Singapore, Singapore
| |
Collapse
|
7
|
Assessment of Electrical Impedance Tomography to Set Optimal Positive End-Expiratory Pressure for Venoarterial Extracorporeal Membrane Oxygenation-Treated Patients. Crit Care Med 2021; 49:923-933. [PMID: 33595959 DOI: 10.1097/ccm.0000000000004892] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patients on venoarterial extracorporeal membrane oxygenation have many risk factors for pulmonary complications in addition to their heart failure. Optimal positive end-expiratory pressure is unknown in these patients. The aim was to evaluate the ability of electrical impedance tomography to help the physician to select the optimal positive end-expiratory pressure in venoarterial extracorporeal membrane oxygenation treated and mechanically ventilated patients during a positive end-expiratory pressure trial. DESIGN Observational prospective monocentric. SETTING University hospital. PATIENTS Patients (n = 23) older than 18 years old, on mechanical ventilation and venoarterial extracorporeal membrane oxygenation. INTERVENTIONS A decreasing positive end-expiratory pressure trial (20-5 cm H2O) in increments of 5 cm H2O was performed and monitored by a collection of clinical parameters, ventilatory and ultrasonographic (cardiac and pulmonary) to define an optimal positive end-expiratory pressure according to respiratory criteria (optimal positive end-expiratory pressure selected by physician with respiratory parameters), and then adjusted according to hemodynamic and cardiac tolerances (optimal positive end-expiratory pressure selected by physician with respiratory, hemodynamic, and echocardiographic parameters). At the same time, electrical impedance tomography data (regional distribution of ventilation, compliance, and overdistension collapse) were recorded and analyzed retrospectively to define the optimal positive end-expiratory pressure. MEASUREMENTS AND MAIN RESULTS The median of this optimal positive end-expiratory pressure was 10 cm H2O in our population. Electrical impedance tomography showed that increasing positive end-expiratory pressure promoted overdistention of ventral lung, maximum at positive end-expiratory pressure 20 cm H20 (34% [interquartile range, 24.5-40]). Decreasing positive end-expiratory pressure resulted in collapse of dorsal lung (29% [interquartile range, 21-45.8]). The optimal positive end-expiratory pressure selected by physician with respiratory parameters was not different from the positive end-expiratory pressure chosen by the electrical impedance tomography. However, there is a negative impact of a high level of intrathoracic pressure on hemodynamic and cardiac tolerances. CONCLUSIONS Our results support that electrical impedance tomography appears predictive to define optimal positive end-expiratory pressure on venoarterial extracorporeal membrane oxygenation, aided by echocardiography to optimize hemodynamic assessment and management.
Collapse
|
8
|
Liu Y, Li CP, Lu PJ, Wang XY, Xiao JY, Gao MD, Wang JX, Li XW, Zhang N, Li CJ, Ma J, Gao J. Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analyses. Bosn J Basic Med Sci 2020; 20:514-523. [PMID: 31782697 PMCID: PMC7664793 DOI: 10.17305/bjbms.2019.4500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/26/2019] [Indexed: 12/22/2022] Open
Abstract
There is little evidence to recommend the optimal invasive mechanical ventilation (IMV) modes and ideal positive end-expiratory pressure stress levels for acute myocardial infarction-cardiogenic shock (AMI-CS) patients. The aim of this study was to compare the mortality outcome in patients with AMI-CS who were treated with percutaneous coronary intervention (PCI) assisted by intra-aortic balloon pump (IABP) + IMV with historical controls. From January 1, 2016 to June 1, 2017, 60 patients were retrospectively enrolled at Tianjin Chest Hospital. Out of these, 88.3% of patients achieved thrombolysis in myocardial infarction (TIMI) flow 3 after PCI. The all-cause mortality rate in-hospital and at 1 year was 25% (95% CI: 0.14–0.36) and 33.9% (0.22–0.46), respectively. A systematic review followed by meta-analysis was performed with four historical studies of patients treated by PCI + IMV with partial IABP, which found an in-hospital mortality rate of 66.0% (95% CI: 0.62–0.71). Recently, a meta-analysis of patients receiving PCI + IABP with partial IMV showed that the 1 year mortality rate was 52.2% (95% CI: 0.47–0.58). In Cox regression analysis of patient data from the current study, lactic acid level ≥4.5 mmol/L, hyperuricemia, and TIMI flow <3 were independent predictors of death at 1 year. All-cause mortality, in-hospital and at 1 year, in patients with AMI-CS treated with PCI + IABP and IMV was lower than in those treated with PCI + partial IABP or IMV. Larger, longer-term direct comparisons are warranted.
Collapse
Affiliation(s)
- Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Chang-Ping Li
- Tianjin Medical University, Heping District, Tianjin, China
| | - Peng-Ju Lu
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Xu-Ying Wang
- Department of Prevention, Tianjin Children's Hospital, Beichen District, Tianjin, China
| | - Jian-Yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Ming-Dong Gao
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Ji-Xiang Wang
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Xiao-Wei Li
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Nan Zhang
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Chun-Jie Li
- Department of Cardiology, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| | - Jun Ma
- Tianjin Medical University, Heping District, Tianjin, China
| | - Jing Gao
- Cardiovascular Institute, Tianjin Chest Hospital, Jinnan District, Tianjin, China
| |
Collapse
|
9
|
Jones TW, Smith SE, Van Tuyl JS, Newsome AS. Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features. J Intensive Care Med 2020; 36:989-1012. [PMID: 32495686 DOI: 10.1177/0885066620928299] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Preexisting heart failure (HF) in patients with sepsis is associated with worse clinical outcomes. Core sepsis management includes aggressive volume resuscitation followed by vasopressors (and potentially inotropes) if fluid is inadequate to restore perfusion; however, large fluid boluses and vasoactive agents are concerning amid the cardiac dysfunction of HF. This review summarizes evidence regarding the influence of HF on sepsis clinical outcomes, pathophysiologic concerns, resuscitation targets, hemodynamic interventions, and adjunct management (ie, antiarrhythmics, positive pressure ventilatory support, and renal replacement therapy) in patients with sepsis and preexisting HF. Patients with sepsis and preexisting HF receive less fluid during resuscitation; however, evidence suggests traditional fluid resuscitation targets do not increase the risk of adverse events in HF patients with sepsis and likely improve outcomes. Norepinephrine remains the most well-supported vasopressor for patients with sepsis with preexisting HF, while dopamine may induce more cardiac adverse events. Dobutamine should be used cautiously given its generally detrimental effects but may have an application when combined with norepinephrine in patients with low cardiac output. Management of chronic HF medications warrants careful consideration for continuation or discontinuation upon development of sepsis, and β-blockers may be appropriate to continue in the absence of acute hemodynamic decompensation. Optimal management of atrial fibrillation may include β-blockers after acute hemodynamic stabilization as they have also shown independent benefits in sepsis. Positive pressure ventilatory support and renal replacement must be carefully monitored for effects on cardiac function when HF is present.
Collapse
Affiliation(s)
- Timothy W Jones
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA
| | - Susan E Smith
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Athens, GA, USA
| | - Joseph S Van Tuyl
- Department of Pharmacy Practice, 14408St Louis College of Pharmacy, St Louis, MO, USA
| | - Andrea Sikora Newsome
- Department of Clinical and Administrative Pharmacy, 15506University of Georgia College of Pharmacy, Augusta, GA, USA.,Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| |
Collapse
|
10
|
Affiliation(s)
- Barry Hill
- Director of Employability (Nursing, Midwifery and Health), Northumbria University, Newcastle upon Tyne
| |
Collapse
|
11
|
Outcomes Associated with Respiratory Failure for Patients with Cardiogenic Shock and Acute Myocardial Infarction: A Substudy of the CULPRIT-SHOCK Trial. J Clin Med 2020; 9:jcm9030860. [PMID: 32245139 PMCID: PMC7141492 DOI: 10.3390/jcm9030860] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) requiring mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population. METHODS Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored 30 days of clinical outcomes in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission. RESULTS Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV had a different risk-profile. Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24 h before admission, elevated heart rate and evidence of triple vessel disease. CONCLUSIONS Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population.
Collapse
|
12
|
Germano N, Summerfield D, Johnson B. A mini review of inhaled beta 2 agonists in acute decompensated heart failure requiring respiratory support. PULMONARY AND CRITICAL CARE MEDICINE 2019; 4:10.15761/pccm.1000161. [PMID: 34423138 PMCID: PMC8375297 DOI: 10.15761/pccm.1000161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Acute decompensated heart failure (HF) results in over one million hospital admissions per year, many requiring invasive or noninvasive mechanical ventilation for respiratory/cardiovascular support. Inhaled beta-2 adrenergic receptor agonists have been shown to be effective at clearance of extravascular lung water in HF patients. However, studies done in the late 1990s and early 2000s, prior to standardization and wide adoption of guideline directed medical therapy for HF, suggested that inhaled beta-2 agonist use increased admissions for HF exacerbations as well as in-hospital mortality. One study even attempted to utilize intravenous Beta-2 agonists in Acute Respiratory Distress Syndrome patients, however the study was stopped prematurely due to an 11% increased mortality in the treatment group. More recently however, studies examining patients who have concurrent diagnoses of chronic obstructive pulmonary disease (COPD) and HF showed that beta-2 agonist therapy resulted in similar or better outcomes compared to controls. Likewise, in-vitro studies, animal models, and studies utilizing chronic heart failure patients treated with nebulized beta-2 agonists with no concurrent respiratory diagnosis had a therapeutic effect of treatment over controls. These studies have the advantage of being performed with the standardization of guideline directed HF medical therapy. In conclusion, while we continue to recommend the use of Beta-2 agonist therapy in patients with concurrent COPD and HF requiring respiratory support, further studies, preferably single or double blinded prospective trials, will need to be performed to determine whether Beta-2 agonist therapy offers morbidity and mortality benefits in patients with strictly acute decompensated heart failure requiring respiratory support.
Collapse
Affiliation(s)
- Nicholas Germano
- Department of Internal Medicine, MercyOne North Iowa Medical Center, USA
| | | | - Bruce Johnson
- Department of Internal Medicine, MercyOne North Iowa Medical Center, USA
| |
Collapse
|
13
|
Helgestad OKL, Ravn HB, Josiassen J, Udesen NLJ, Møller JE. Mechanical respiratory support in cardiogenic shock: reply. Eur J Heart Fail 2019; 22:168-169. [PMID: 31729129 DOI: 10.1002/ejhf.1618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Ole K L Helgestad
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Hanne B Ravn
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiac Anaesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Josiassen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Nanna L J Udesen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
14
|
Vistisen ST, Enevoldsen JN, Greisen J, Juhl-Olsen P. What the anaesthesiologist needs to know about heart-lung interactions. Best Pract Res Clin Anaesthesiol 2019; 33:165-177. [PMID: 31582096 DOI: 10.1016/j.bpa.2019.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The impact of positive pressure ventilation extends the effect on lungs and gas exchange because the altered intra-thoracic pressure conditions influence determinants of cardiovascular function. These mechanisms are called heart-lung interactions, which conceptually can be divided into two components (1) The effect of positive airway pressure on the cardiovascular system, which may be more or less pronounced under various pathologic cardiac conditions, and (2) The effect of cyclic airway pressure swing on the cardiovascular system, which can be useful in the interpretation of the individual patient's current haemodynamic state. It is imperative for the anaesthesiologist to understand the fundamental mechanisms of heart-lung interactions, as they are a foundation for the understanding of optimal, personalised cardiovascular treatment of patients undergoing surgery in general anaesthesia. The aim of this review is thus to describe what the anaesthesiologist needs to know about heart-lung interactions.
Collapse
Affiliation(s)
- Simon T Vistisen
- Institute of Clinical Medicine, Aarhus University, Denmark; Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark.
| | - Johannes N Enevoldsen
- Institute of Clinical Medicine, Aarhus University, Denmark; Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark.
| | - Jacob Greisen
- Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| | - Peter Juhl-Olsen
- Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark; Institute of Clinical Medicine, Aarhus University, Denmark.
| |
Collapse
|
15
|
Miller DL, Dong Z, Dou C, Patterson B, Raghavendran K. Pulmonary Capillary Hemorrhage Induced by Acoustic Radiation Force Impulse Shear Wave Elastography in Ventilated Rats. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:2575-2587. [PMID: 30702763 PMCID: PMC6771037 DOI: 10.1002/jum.14950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/13/2018] [Accepted: 01/06/2019] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Diagnostic ultrasound (DUS) imaging can induce pulmonary capillary hemorrhage (PCH), possibly related to the ultrasonic radiation surface pressure arising from reflection at the lung blood-air interfaces. Acoustic radiation force impulse (ARFI) elastography is a relatively new DUS mode with high-energy "push pulses" used to move tissue and generate shear waves. The objective of this study was to characterize PCH induced by the ARFI elastographic mode for comparison with other previously tested DUS modes. METHODS Pulmonary capillary hemorrhage induction was examined for ARFI elastographic frames with 5.7-MHz push pulses (Acuson S3000; Siemens Medical Solutions, Mountain View, CA), which had a derated PRPA of 2.6 MPa. Groups of rats with tracheal tube placement had no ventilation (spontaneous breathing), intermittent positive pressure ventilation (IPPV), or IPPV plus 8 cm H2 O of positive end-expiratory pressure (PEEP). Exposure was to 1 or 20 manually triggered image frame acquisitions. The PCH area was measured on the lung surface. RESULTS All 20-frame exposure groups, and even the single-frame group, had significant PCH relative to shams. Single-frame exposures produced significantly less PCH (P = .002) than 20-frame exposures in rats with a tracheal tube only (spontaneous breathing). The PEEP inhibited the PCH and produced about half of the PCH area induced for IPPV without PEEP (P = .014). CONCLUSIONS The PCH results were comparable with those from a previous study using B-mode or color Doppler exposure for 5 minutes; however, these modes delivered many more pulses for continuous imaging frames, suggesting that the ARFI elastographic frames were individually much more effective.
Collapse
Affiliation(s)
- Douglas L. Miller
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Zhihong Dong
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Chunyan Dou
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | - Brandon Patterson
- Department of Radiology, University of Michigan, Ann Arbor, MI. 48109
| | | |
Collapse
|
16
|
Louro LF, Raszplewicz J, Hodgkiss‐Geere H, Pappa E. Postobstructive negative pressure pulmonary oedema in a dog. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Luís Filipe Louro
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Joanna Raszplewicz
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Hannah Hodgkiss‐Geere
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| | - Eirini Pappa
- Department of Small Animal Clinical ScienceInstitute of Veterinary ScienceUniversity of LiverpoolLiverpoolUK
| |
Collapse
|
17
|
Weipert KF, Bauer T, Nef HM, Hochadel M, Weidinger F, Gitt AK, Zeymer U, Hamm CW. Incidence and outcome of peri-procedural cardiogenic shock: results from the international Euro Heart Survey PCI registry. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:120-127. [PMID: 30618264 DOI: 10.1177/2048872618822460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is a large body of literature on acute myocardial infarction complicated by cardiogenic shock. However, very little is known about patients who are initially haemodynamically stable and develop cardiogenic shock during percutaneous coronary intervention. METHODS A total of 47,407 consecutive patients were prospectively enrolled in the PCI Registry of the Euro Heart Survey Programme. We analysed interventions with peri-procedural complications that were classified as 'shock induced by procedure' on the case report form. Clinical and procedural characteristics as well as hospital outcomes of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention were evaluated. Patients with haemodynamic instability at presentation prior to intervention were excluded. RESULTS A total of 68 patients (0.2%) developed cardiogenic shock as a complication of percutaneous coronary intervention. The majority of cases comprised acute coronary syndrome (60.3%) with complex lesions (93.1%). Most patients had multi-vessel disease (82.1%) and an ejection fraction less than 40% (58.1%). In the multivariate analysis, left main disease (odds ratio (OR) 9.51), ST-segment elevation myocardial infarction (OR 5.31) and multi-vessel disease without left main involvement (OR 3.32) were the strongest independent predictors of peri-procedural cardiogenic shock. Among these patients procedural success was low (66.1%) and in-hospital mortality was very high (39.7%). CONCLUSIONS In this real-world registry the rate of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention was very low. Patients at a priori high risk were more likely to be affected by this complication. The in-hospital mortality rate of these patients was very high.
Collapse
Affiliation(s)
- Kay F Weipert
- Department of Cardiology, Justus-Liebig University of Giessen, Germany.,Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany
| | - Timm Bauer
- Department of Cardiology, Justus-Liebig University of Giessen, Germany
| | - Holger M Nef
- Department of Cardiology, Justus-Liebig University of Giessen, Germany
| | | | - Franz Weidinger
- Department of Cardiology, Rudolfstiftung Hospital, Vienna, Austria
| | - Anselm K Gitt
- Institut für Herzinfarktforschung, Germany.,Department of Cardiology, Heart Center Ludwigshafen, Germany
| | - Uwe Zeymer
- Institut für Herzinfarktforschung, Germany.,Department of Cardiology, Heart Center Ludwigshafen, Germany
| | - Christian W Hamm
- Department of Cardiology, Justus-Liebig University of Giessen, Germany.,Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Germany
| |
Collapse
|
18
|
Gupta B, Kerai S, Kakkar K, Gupta L. Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting. Indian J Crit Care Med 2019; 23:458-461. [PMID: 31749554 PMCID: PMC6842833 DOI: 10.5005/jp-journals-10071-23264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
High-flow nasal oxygen therapy warms and humidifies gases, allows better clearance of secretions, along with providing added benefits like preventing dehydration of airway surface, while decreasing atelectasis and thereby, offering comfort to the patient. While its effect on critically ill patients is still in its pioneering phase, there is lack of substantial evidence on the use of high-flow nasal cannula in cardiac patients with type I respiratory failure. We found it worthwhile to share our experience of its use in elderly and postpartum patients with moderate-to-severe pulmonary hypertension, with associated comorbidities and type I respiratory failure, with do-not-intubate or defer intubation status. In patients with pulmonary hypertension (PHT) and respiratory failure, endotracheal intubation followed by initiation of mechanical ventilation may have detrimental hemodynamic effects. Increase in lung volumes and decrease in functional residual capacity lead to increase in pulmonary hypertension and right ventricle afterload. If a patient has right heart failure, lung hyperinflation can fatally reduce cardiac output. High-flow nasal oxygen therapy may be of an advantage in these scenarios. How to cite this article: Gupta B, Kerai S, Kakkar K, Gupta L. Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting. Indian J Crit Care Med 2019;23(10):458-461.
Collapse
Affiliation(s)
- Bhavna Gupta
- Department of Anesthesia, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sukhyanti Kerai
- Department of Anesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| | - Kamna Kakkar
- Department of Anesthesia, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Lalit Gupta
- Department of Anesthesiology and Critical Care, Maulana Azad Medical College, New Delhi, India
| |
Collapse
|
19
|
Alviar CL, Miller PE, McAreavey D, Katz JN, Lee B, Moriyama B, Soble J, van Diepen S, Solomon MA, Morrow DA. Positive Pressure Ventilation in the Cardiac Intensive Care Unit. J Am Coll Cardiol 2018; 72:1532-1553. [PMID: 30236315 PMCID: PMC11032173 DOI: 10.1016/j.jacc.2018.06.074] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 12/16/2022]
Abstract
Contemporary cardiac intensive care units (CICUs) provide care for an aging and increasingly complex patient population. The medical complexity of this population is partly driven by an increased proportion of patients with respiratory failure needing noninvasive or invasive positive pressure ventilation (PPV). PPV often plays an important role in the management of patients with cardiogenic pulmonary edema, cardiogenic shock, or cardiac arrest, and those undergoing mechanical circulatory support. Noninvasive PPV, when appropriately applied to selected patients, may reduce the need for invasive mechanical PPV and improve survival. Invasive PPV can be lifesaving, but has both favorable and unfavorable interactions with left and right ventricular physiology and carries a risk of complications that influence CICU mortality. Effective implementation of PPV requires an understanding of the underlying cardiac and pulmonary pathophysiology. Cardiologists who practice in the CICU should be proficient with the indications, appropriate selection, potential cardiopulmonary interactions, and complications of PPV.
Collapse
Affiliation(s)
- Carlos L Alviar
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida
| | - P Elliott Miller
- Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut; Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Dorothea McAreavey
- Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jason N Katz
- Divisions of Cardiology and Pulmonary and Critical Care Medicine, University of North Carolina, Center for Heart and Vascular Care Chapel Hill, Chapel Hill, North Carolina
| | - Burton Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Brad Moriyama
- Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jeffrey Soble
- Division of Cardiovascular Medicine, Rush University Medical Center, Chicago, Illinois
| | - Sean van Diepen
- Department of Critical Care and Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael A Solomon
- Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, Maryland; Cardiovascular Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - David A Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| |
Collapse
|
20
|
Miller DL, Dong Z, Dou C, Raghavendran K. Pulmonary Capillary Hemorrhage Induced by Diagnostic Ultrasound in Ventilated Rats. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1810-1817. [PMID: 29779887 PMCID: PMC6168079 DOI: 10.1016/j.ultrasmedbio.2018.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/05/2018] [Accepted: 04/18/2018] [Indexed: 05/08/2023]
Abstract
Pulmonary capillary hemorrhage (PCH) can be induced by diagnostic ultrasound-a potential safety issue. Anesthetized rats were intubated for intermittent positive-pressure ventilation (IPPV) with 0 end-expiratory pressure, +4 cm H2O end-expiratory pressure (PEEP) and -4 cm H2O end-expiratory pressure (NEEP). Rats were imaged at 7.6 MHz with a Philips HDI 5000 ultrasound machine. The output was low (mechanical index [MI] = 0.22) for aiming and then was raised for 5 min in 20 different exposure groups with n = 8. Peak rarefactional pressure amplitudes were measured in water and de-rated for chest attenuation. The PCH areas were measured on the lung surface. At 2.2 MPa, PCH was 9.3 ± 6.6 mm2 for IPPV, 1.6 ± 3.2 mm2 for PEEP (p <0.001) and 26.8 ± 6.4 mm2 for NEEP (p <0.001). Thresholds were 1.3 MPa for IPPV, 2.1 MPa for PEEP and 1.0 MPa for NEEP. The small ventilator pressures subtracted or added to trans-capillary stress generated by diagnostic ultrasound pulses, virtually eliminating PCH for PEEP but enhancing PCH for NEEP.
Collapse
Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
| | - Zhihong Dong
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
21
|
Qu Y, Zheng Q, Ni C, Cui Z, Guo X. Metastatic leiomyosarcoma presenting as a lung mass with left atrial extension: case report and anesthetic management. Ther Clin Risk Manag 2018; 14:141-147. [PMID: 29403281 PMCID: PMC5783153 DOI: 10.2147/tcrm.s153484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Lung metastasis of leiomyosarcoma that protrudes into the left atrium is an extremely rare condition. Severe complications may occur that prominently increase the mortality during the perioperative period. Currently, the anesthetic management reports are limited and there is no generally acknowledged algorithm available. Case presentation A 67-year-old man presented with cough and dyspnea for 10 days. Workup revealed bilateral pulmonary effusion. Transthoracic echocardiography showed a large mass in the left atrium. Urgent surgical resection under cardiopulmonary bypass was performed. We focused on oxygenation improvement and cardiac function management by applying protective ventilation with low positive end expiratory pressure, low dose inotropic agents, and other methods to maintain stable homeostasis. Results of biopsy established a diagnosis of metastatic leiomyosarcoma. Conclusion We reported a case of metastatic leiomyosarcoma presenting as a lung mass with left atrial extension and anesthetic management during surgical resection. Treating acute heart failure and refractory hypoxemia was the key focus perioperatively.
Collapse
Affiliation(s)
| | | | | | - Zhongqi Cui
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, People's Republic of China
| | | |
Collapse
|
22
|
Increasing Levels of Positive End-expiratory Pressure Improve the Left Ventricular Strain. J Thorac Imaging 2017; 32:333-339. [PMID: 28489667 DOI: 10.1097/rti.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal of this study was to evaluate possible changes in the left myocardial performance of patients with cardiogenic shock (CS) during ascending levels of positive end-expiratory pressure (PEEP) using speckle-tracking echocardiography. MATERIALS AND METHODS This was an interventional clinical study performed on CS patients under mechanical ventilation. These patients underwent echocardiography after 15 to 30 minutes of progressive increases in PEEP zero end-expiratory pressure (ZEEP) (PEEP 5, PEEP 10, PEEP 15 cm H2O). We evaluated the changes caused by these increasing levels of PEEP on the E/E' ratio and the parameters of left ventricular systolic and diastolic functions, including longitudinal strain (S) and strain rate (SR). Analyses of mean values were carried out using analysis of variance. RESULTS A total of 65 CS patients were included. Their mean age was 68.58±14.61 years. Progressive increases in PEEP induced a significant decrease in the E/E' ratio (ZEEP=12.87±1.81; PEEP=5, 8.39±3.61; PEEP=10, 6.34±1.73; and PEEP=15, 7.10±0.37; P<0.0001). Although we did not find significant changes in left ventricular ejection fraction, a clear increase in left ventricular S and SR occurred (ZEEP=-13, 15±1.27; PEEP=5, -16.97±4.01; PEEP=10, -16.89±0.46; PEEP=15, -15.39±4.21; and ZEEP=-1.02±0.02; PEEP=5, -1.49±0.13; PEEP=10, -1.57±0.21; PEEP=15, -1.24±0.29, respectively; all values were significant). CONCLUSIONS Increasing levels of PEEP improve the left ventricular S and SR. PEEP levels could modify the performance of left ventricular fibers.
Collapse
|
23
|
Management of Mechanical Ventilation in Decompensated Heart Failure. J Cardiovasc Dev Dis 2016; 3:jcdd3040033. [PMID: 29367576 PMCID: PMC5715720 DOI: 10.3390/jcdd3040033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 02/04/2023] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence.
Collapse
|
24
|
Hariyanto H, Yahya CQ, Wibowo P, Tampubolon OE. A tale of the broken heart: peripartum cardiomyopathy, a case report. MEDICAL JOURNAL OF INDONESIA 2016. [DOI: 10.13181/mji.v25i1.1278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Progressive dyspnea following childbirth warrants a prompt suspicion into the diagnosis of peripartum cardiomyopathy, PPCM. Pump failure causes an inadequate cardiac output which ultimately contributes to PPCM high mortality rate; however early airway control, vigilant fluid balance and vasoactive support will substantially reduce the incidence of patients falling into decompensated heart failure. More importantly, it is imperative that these patients are cared in a setting where continuous hemodynamic monitoring is available. This case report serves as a reminder not to focus end-point therapy solely on blood pressure readings, but to observe signs and symptoms of hypoperfusion such as cold clammy skin, cool extremities, decreased urine output and mental status.
Collapse
|
25
|
Liu H, Wu X, Zhao X, Zhu P, Han L. Intra-aortic balloon pump combined with mechanical ventilation for treating patients aged > 60 years in cardiogenic shock: Retrospective analysis. J Int Med Res 2016; 44:433-43. [PMID: 27020597 PMCID: PMC5536692 DOI: 10.1177/0300060515621443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/13/2015] [Indexed: 01/15/2023] Open
Abstract
Objective To examine if mechanical ventilation with positive end-expiratory pressure (PEEP) combined with intra-aortic balloon pump (IABP) provided a better outcome than IABP alone for the treatment of cardiogenic shock after acute myocardial infarction in patients aged > 60 years. Methods This was a retrospective analysis of data from patients in cardiogenic shock, refractory to pharmacological therapy and treated at a geriatric coronary care unit. Results Sixty-two patients were eligible for study inclusion: 33 received IABP alone; 29 received IABP combined with mechanical ventilation. Patients in the IABP + mechanical ventilation group had lower mean arterial blood pressure (BP), systolic BP and partial pressure of oxygen compared with the IABP group, indicating worse cardiac and pulmonary function. In addition, higher rates of pulmonary infection and renal insufficiency were observed in the IABP + mechanical ventilation group than in the IABP group. A statistically significant improvement of left ventricular function before and after treatment was observed in the IABP + mechanical ventilation group, but not in the IABP group. Pulmonary infection and renal insufficiency were risk factors for all-cause in-hospital mortality; successful revascularization was a negative risk factor. There was no between-group difference in survival. Conclusion Mechanical ventilation with an appropriate level of PEEP appears to enhance the beneficial effects of IABP on left ventricular function for patients in cardiogenic shock.
Collapse
Affiliation(s)
- Hongwei Liu
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Haidian District, Beijing, China
| | - Xueping Wu
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Haidian District, Beijing, China
| | - Xiaoning Zhao
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Haidian District, Beijing, China
| | - Ping Zhu
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Haidian District, Beijing, China
| | - Lina Han
- Department of Geriatric Cardiology, General Hospital of Chinese People's Liberation Army, Haidian District, Beijing, China
| |
Collapse
|
26
|
Barbas CSV, Ísola AM, Farias AMDC, Cavalcanti AB, Gama AMC, Duarte ACM, Vianna A, Serpa Neto A, Bravim BDA, Pinheiro BDV, Mazza BF, de Carvalho CRR, Toufen Júnior C, David CMN, Taniguchi C, Mazza DDDS, Dragosavac D, Toledo DO, Costa EL, Caser EB, Silva E, Amorim FF, Saddy F, Galas FRBG, Silva GS, de Matos GFJ, Emmerich JC, Valiatti JLDS, Teles JMM, Victorino JA, Ferreira JC, Prodomo LPDV, Hajjar LA, Martins LC, Malbouisson LMS, Vargas MADO, Reis MAS, Amato MBP, Holanda MA, Park M, Jacomelli M, Tavares M, Damasceno MCP, Assunção MSC, Damasceno MPCD, Youssef NCM, Teixeira PJZ, Caruso P, Duarte PAD, Messeder O, Eid RC, Rodrigues RG, de Jesus RF, Kairalla RA, Justino S, Nemer SN, Romero SB, Amado VM. Brazilian recommendations of mechanical ventilation 2013. Part 2. Rev Bras Ter Intensiva 2016; 26:215-39. [PMID: 25295817 PMCID: PMC4188459 DOI: 10.5935/0103-507x.20140034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/13/2022] Open
Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill
patients are evolving, as much evidence indicates that ventilation may have positive
effects on patient survival and the quality of the care provided in intensive care
units in Brazil. For those reasons, the Brazilian Association of Intensive Care
Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and
the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e
Tisiologia - SBPT), represented by the Mechanical Ventilation Committee
and the Commission of Intensive Therapy, respectively, decided to review the
literature and draft recommendations for mechanical ventilation with the goal of
creating a document for bedside guidance as to the best practices on mechanical
ventilation available to their members. The document was based on the available
evidence regarding 29 subtopics selected as the most relevant for the subject of
interest. The project was developed in several stages, during which the selected
topics were distributed among experts recommended by both societies with recent
publications on the subject of interest and/or significant teaching and research
activity in the field of mechanical ventilation in Brazil. The experts were divided
into pairs that were charged with performing a thorough review of the international
literature on each topic. All the experts met at the Forum on Mechanical Ventilation,
which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to
collaboratively draft the final text corresponding to each sub-topic, which was
presented to, appraised, discussed and approved in a plenary session that included
all 58 participants and aimed to create the final document.
Collapse
Affiliation(s)
- Carmen Sílvia Valente Barbas
- Corresponding author: Carmen Silvia Valente Barbas, Disicplina de
Pneumologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo, Avenida Dr. Eneas de Carvalho Aguiar, 44, Zip code - 05403-900 - São Paulo
(SP), Brazil, E-mail:
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Acute Respiratory Failure. SURGICAL INTENSIVE CARE MEDICINE 2016. [PMCID: PMC7153455 DOI: 10.1007/978-3-319-19668-8_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Acute respiratory failure accounts for 25–40 % of ICU admissions and carries a mortality rate of 30 % or more. In this chapter, we classify acute respiratory failure in two main types, based on their primary physiologic abnormality:Disorders of the airways, where increase of airway resistance to gas flow determines pharmacologic treatment and ventilatory strategies. These disorders are mainly asthma and chronic obstructive pulmonary disease. Disorders of the alveoli, where a decrease of lung compliance mandates the use of higher ventilatory pressures that can recruit but also damage the lung. These disorders include the acute respiratory distress syndrome, pneumonia, acute cardiogenic pulmonary edema, and influenza.
Additional types of acute respiratory failure are described elsewhere in this book: disorders that result from neuromuscular disease in Chap. 10.1007/978-3-319-19668-8_19 and pulmonary disorders of the circulation, including pulmonary thromboembolism, in Chap. 10.1007/978-3-319-19668-8_27. Finally, we provide a section on weaning from mechanical ventilation, which includes the pathophysiology of the ventilatory load imposed by the prolonged acute respiratory failure, the possible ways to support the weakened respiratory system, and the current process of screening and testing for readiness to remove the ventilator.
Collapse
|
28
|
Tomita Y, Kasai T. Effectiveness of adaptive servo-ventilation. World J Respirol 2015; 5:112-125. [DOI: 10.5320/wjr.v5.i2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 04/16/2015] [Accepted: 06/11/2015] [Indexed: 02/06/2023] Open
Abstract
Adaptive servo-ventilation (ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea (CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea (OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure (CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatment-emergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.
Collapse
|
29
|
Lovas A, Németh MF, Trásy D, Molnár Z. Lung recruitment can improve oxygenation in patients ventilated in continuous positive airway pressure/pressure support mode. Front Med (Lausanne) 2015; 2:25. [PMID: 25954744 PMCID: PMC4404945 DOI: 10.3389/fmed.2015.00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/05/2015] [Indexed: 11/28/2022] Open
Abstract
Background Recruitment maneuvers are often used in critical care patients with hypoxemic respiratory failure. Although continuous positive airway pressure/pressure support (CPAP/PS) ventilation is a frequently used approach, but whether lung recruitment also improves oxygenation in spontaneously breathing patients has not been investigated yet. The primary objective was to analyze the effect of recruitment maneuver on oxygenation in patients ventilated in CPAP/PS mode. Methods Following baseline measurements PEEP was increased by 5 cmH2O. Recruitment maneuver was applied for 40 s with 40 cmH2O of PS. Measurements of the difference in PaO2/FiO2 and airway parameters measured by the ventilator were recorded immediately after recruitment then 15 and 30 min later. Thirty patients ventilated in CPAP/PS mode with a PEEP ≥5 cmH2O were enrolled in this prospective, observational study if their PaO2/FiO2 ratio was <300 mmHg or required an FiO2 >0.5. Results Following recruitment maneuver patients were considered as non-responders (NR, n = 15) if difference of PaO2/FiO2 <20% and responders (R, n = 15) if difference of PaO2/FiO2 ≥20%. In the NR-group, PaO2/FiO2 decreased non-significantly from baseline: median [interquartile], PaO2/FiO2 = 176 [120–186] vs. after recruitment: 169 [121–182] mmHg, P = 0.307 while in the R-group there was significant improvement: 139 [117–164] vs. 230 [211–323] mmHg, P = 0.01. At the same time points, dead space to tidal volume ratio (Vds/Vte) significantly increased in the NR-group Vds/Vte = 32 [27–37] vs. 36 [25–42]%, P = 0.013 but no significant change was observed in the R-group: 26 [22–34] vs. 27 [24–33]%, P = 0.386. Conclusion Recruitment maneuver improved PaO2/FiO2 ratio by ≥20% in 50% of patients ventilated in CPAP/PS mode.
Collapse
Affiliation(s)
- András Lovas
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged , Szeged , Hungary
| | - Márton Ferenc Németh
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged , Szeged , Hungary
| | - Domonkos Trásy
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged , Szeged , Hungary
| | - Zsolt Molnár
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged , Szeged , Hungary
| |
Collapse
|
30
|
Gajanana D, Seetha Rammohan H, Alli O, Romero-Corral A, Purushottam B, Ponamgi S, Figueredo VM, Pressman GS. Tricuspid Annular Plane Systolic Excursion and Its Association with Mortality in Critically Ill Patients. Echocardiography 2015; 32:1222-7. [PMID: 25728401 DOI: 10.1111/echo.12926] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Transient left ventricular dysfunction can occur under conditions of extreme emotional or physiological stress. There is little data on right ventricular function in such situations. METHODS One hundred twenty patients admitted to an ICU with a noncardiac illness were studied. Those with documented coronary disease, ejection fraction <40%, sepsis, or intracranial hemorrhage were excluded. Echocardiograms were performed within 24 hours of admission. Tricuspid annular plane systolic excursion (TAPSE) was measured to assess right ventricular systolic function. Plasma catecholamines (norepinephrine, epinephrine, dopamine) were measured on admission. Clinical and demographic data were collected, along with data on ICU length of stay (LOS), hospital LOS, and in-hospital and long-term mortality. TAPSE was tested for correlation with adverse outcomes and length of stay. RESULTS Mean TAPSE for the group was 2.05 ± 0.66 cm. Based on area under the ROC curve analysis, TAPSE <2.4 cm was the best cutoff for predicting in-hospital and long-term mortality. There were 13 in-hospital deaths, 12 in the group with TAPSE <2.4 cm and one among those with TAPSE ≥2.4 cm. On multivariate analysis, TAPSE <2.4 cm was a significant predictor of in-hospital mortality (χ(2) = 4.6, P = 0.03). When tested against hospital LOS, an inverse correlation was found (P = 0.04). No association was found between TAPSE and catecholamine levels. CONCLUSIONS Right ventricular systolic function, as assessed by TAPSE, has important prognostic value in critically ill patients. Mean values were lower in patients who died in-hospital versus those who survived to discharge. In addition, patients with TAPSE <2.4 cm had a longer hospital length of stay.
Collapse
Affiliation(s)
- Deepakraj Gajanana
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Harish Seetha Rammohan
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Oluseun Alli
- Division of Cardiovascular disease, UAB School of Medicine, Birmingham, Alabama
| | - Abel Romero-Corral
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Bhaskar Purushottam
- Zena & Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York
| | - Shiva Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, Minnesota
| | - Vincent M Figueredo
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Gregg S Pressman
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania
| |
Collapse
|
31
|
Van Herck JL, Claeys MJ, De Paep R, Van Herck PL, Vrints CJ, Jorens PG. Management of cardiogenic shock complicating acute myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 4:278-97. [DOI: 10.1177/2048872614568294] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 12/23/2014] [Indexed: 01/10/2023]
Affiliation(s)
- Jozef L Van Herck
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Marc J Claeys
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Rudi De Paep
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Paul L Van Herck
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Christiaan J Vrints
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| | - Philippe G Jorens
- Department of Intensive Care Medicine and Cardiology, Antwerp University Hospital, University of Antwerp, Belgium
| |
Collapse
|
32
|
Kato T, Suda S, Kasai T. Positive airway pressure therapy for heart failure. World J Cardiol 2014; 6:1175-91. [PMID: 25429330 PMCID: PMC4244615 DOI: 10.4330/wjc.v6.i11.1175] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/16/2014] [Accepted: 09/18/2014] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a life-threatening disease and is a growing public health concern. Despite recent advances in pharmacological management for HF, the morbidity and mortality from HF remain high. Therefore, non-pharmacological approaches for HF are being developed. However, most non-pharmacological approaches are invasive, have limited indication and are considered only for advanced HF. Accordingly, the development of less invasive, non-pharmacological approaches that improve outcomes for patients with HF is important. One such approach may include positive airway pressure (PAP) therapy. In this review, the role of PAP therapy applied through mask interfaces in the wide spectrum of HF care is discussed.
Collapse
Affiliation(s)
- Takao Kato
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Shoko Suda
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| | - Takatoshi Kasai
- Takao Kato, Department of Cardiology, Juntendo University School of Medicine, Tokyo 113-8421, Japan
| |
Collapse
|
33
|
Abstract
Perspectives on invasive and noninvasive ventilatory support for critically ill patients are evolving, as much evidence indicates that ventilation may have positive effects on patient survival and the quality of the care provided in intensive care units in Brazil. For those reasons, the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB) and the Brazilian Thoracic Society (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT), represented by the Mechanical Ventilation Committee and the Commission of Intensive Therapy, respectively, decided to review the literature and draft recommendations for mechanical ventilation with the goal of creating a document for bedside guidance as to the best practices on mechanical ventilation available to their members. The document was based on the available evidence regarding 29 subtopics selected as the most relevant for the subject of interest. The project was developed in several stages, during which the selected topics were distributed among experts recommended by both societies with recent publications on the subject of interest and/or significant teaching and research activity in the field of mechanical ventilation in Brazil. The experts were divided into pairs that were charged with performing a thorough review of the international literature on each topic. All the experts met at the Forum on Mechanical Ventilation, which was held at the headquarters of AMIB in São Paulo on August 3 and 4, 2013, to collaboratively draft the final text corresponding to each sub-topic, which was presented to, appraised, discussed and approved in a plenary session that included all 58 participants and aimed to create the final document.
Collapse
|
34
|
|