Hemodynamic effects of different lung-protective ventilation strategies in closed-chest pigs with normal lungs

Roosens, Carl; Amà, Ruggero; Leather, H. Alex; Segers, Patrick; Sorbara, Carlo; Wouters, Patrick; Poelaert, Jan

doi:10.1097/01.ccm.0000242758.37427.16

Cited by 24 publications

(15 citation statements)

References 46 publications

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“…Prone ventilation, although not affecting mortality in acute lung injury, may unload the RV through effects on airway pressure and improved alveolar ventilation (47). The effects of high-frequency oscillatory ventilation on RV function are poorly defined, although decreases in CO are described (48,49). Although transient improvements in oxygenation may also be achieved with recruitment maneuvers, these may cause decreased venous return and hypotension (50) and should therefore only be used with extreme caution when significant hypoxemia is present.…”

Section: Treatment Of Acute Rvfmentioning

confidence: 97%

Medical and Surgical Treatment of Acute Right Ventricular Failure

Lahm

McCaslin

Wozniak

et al. 2010

Journal of the American College of Cardiology

167

138

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Acute right ventricular (RV) failure is a frequent and serious clinical challenge in the intensive care unit. It is usually seen as a consequence of left ventricular failure, pulmonary embolism, pulmonary hypertension, sepsis, acute lung injury or after cardiothoracic surgery. The presence of acute RV failure not only carries substantial morbidity and mortality, but also complicates the use of commonly used treatment strategies in critically ill patients. In contrast to the left ventricle, the RV remains relatively understudied, and investigations of the treatment of isolated RV failure are rare and usually limited to nonrandomized observations. We searched PubMed for papers in the English language by using the search words right ventricle, right ventricular failure, pulmonary hypertension, sepsis, shock, acute lung injury, cardiothoracic surgery, mechanical ventilation, vasopressors, inotropes, and pulmonary vasodilators. These were used in various combinations. We read the abstracts of the relevant titles to confirm their relevance, and the full papers were then extracted. References from extracted papers were checked for any additional relevant papers. This review summarizes the general measures, ventilation strategies, vasoactive substances, and surgical as well as mechanical approaches that are currently used or actively investigated in the treatment of the acutely failing RV.

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Section: Treatment Of Acute Rvfmentioning

confidence: 97%

Medical and Surgical Treatment of Acute Right Ventricular Failure

Lahm

McCaslin

Wozniak

et al. 2010

Journal of the American College of Cardiology

167

138

View full text Add to dashboard Cite

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“…However, PEEP may cause hyperinflation, which in turn alters autonomic tone and increases PVR. In addition, lung-protective ventilation leads to a decrease in lung volume with secondary alveolar collapse; these are responsible for hypoxia, thus further increasing PVR ("hypoxic pulmonary vasoconstriction") [79,80]. Recruitment maneuvers and positive-pressure ventilation can reverse hypoxic pulmonary vasoconstriction and reduce pulmonary artery pressure.…”

Section: Mechanical Ventilation and Septic Cardiomyopathymentioning

confidence: 98%

Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment

Antonucci

Fiaccadori

Donadello

et al. 2014

Journal of Critical Care

252

187

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“…Experience with HFOV following cardiac surgery is limited, due to concerns about hemodynamic impairment in animal and human studies [6,9-13]. However, HFOV has been associated with a significant reduction in pulmonary vascular resistance (PVR) after the Fontan procedure in children [14].…”

Section: Introductionmentioning

confidence: 99%

High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis

et al. 2011

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IntroductionExperience with high-frequency oscillatory ventilation (HFOV) after congenital cardiac surgery is limited despite evidence about reduction in pulmonary vascular resistance after the Fontan procedure. HFOV is recommended in adults and children with acute respiratory distress syndrome. The aim of the present study was to assess associations between commencement of HFOV on the day of surgery and length of mechanical ventilation, length of Intensive Care Unit (ICU) stay and mortality in neonates and infants with respiratory distress following cardiac surgery.MethodsA logistic regression model was used to develop a propensity score, which accounted for the probability of being switched from conventional mechanical ventilation (CMV) to HFOV on the day of surgery. It included baseline characteristics, type of procedure and postoperative variables, and was used to match each patient with HFOV with a control patient, in whom CMV was used exclusively. Length of mechanical ventilation, ICU stay and mortality rates were compared in the matched set.ResultsOverall, 3,549 neonates and infants underwent cardiac surgery from January 2001 through June 2010, 120 patients were switched to HFOV and matched with 120 controls. After adjustment for the delay to sternal closure, duration of renal replacement therapy, occurrence of pulmonary hypertension and year of surgery, the probability of successful weaning over time and the probability of ICU delivery over time were significantly higher in patients with HFOV, adjusted hazard ratios and 95% confidence intervals: 1.63, 1.17 to 2.26 (P = 0.004). and 1.65, 95% confidence intervals: 1.20 to 2.28 (P = 0.002) respectively. No association was found with mortality.ConclusionsWhen commenced on the day of surgery in neonates and infants with respiratory distress following cardiac surgery, HFOV was associated with shorter lengths of mechanical ventilation and ICU stay than CMV.

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Hemodynamic effects of different lung-protective ventilation strategies in closed-chest pigs with normal lungs

Abstract: In the absence of a fluid resuscitation strategy, CLPV and HFOV caused decreased mean arterial pressure, cardiac output, and stroke volume and worsened oxygenation in this normal lung animal model. This resulted primarily from a biventricular decrease in preload.

Cited by 24 publications

References 46 publications

Medical and Surgical Treatment of Acute Right Ventricular Failure

Medical and Surgical Treatment of Acute Right Ventricular Failure

Myocardial depression in sepsis: From pathogenesis to clinical manifestations and treatment

High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis

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