Human pulmonary vascular response to 4 h of hypercapnia  and hypocapnia measured using Doppler echocardiography

Balanos, George M.; Talbot, Nick P.; Dorrington, Keith L.; Robbins, Peter A.

doi:10.1152/japplphysiol.00890.2002

Cited by 155 publications

(115 citation statements)

References 20 publications

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“…However, there were more severe patients undergoing RA, indicated by both haemodynamics and the fact that significantly more patients on specific PAH therapy received RA than GA. The use of GA may increase PVR through several mechanisms, including increased sympathetic stimulation during airway instrumentation on laryngoscopy [39], effects of volatile agents [40], high airway plateau pressure due to the effects of positive-pressure mechanical ventilation [12,13], hypoxia [15] and hypercapnia [16]. The present data suggested that more complications occurred in those with higher PET,CO 2 and peak airway pressure, although many confounding factors may affect these values.…”

Section: Discussionmentioning

confidence: 61%

“…A common mode of death appears to be minor stimulation resulting in tachycardia or increased PVR, followed by refractory hypotension, hypoxia and ultimately cardiovascular collapse [12,13] due to a downwards spiral of worsening right ventricular function [14]. Perioperative increases in PVR may be precipitated by hypoxia [15], hypercapnia [16], high airway plateau pressure due to the effects of positive-pressure mechanical ventilation [17] and atelectasis or may follow acute pulmonary embolism [18]. Such PH complications, including death, may occur up to 1 week post-operatively [19,20], or even later, reported following delivery by Caesarean section [21,22].…”

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confidence: 99%

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Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

Eur Respir J

121

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The anaesthetic management and follow-up of well-characterised patients with pulmonary arterial hypertension presenting for noncardiothoracic nonobstetric surgery has rarely been described.The details of consecutive patients and perioperative complications during the period January 2000 to December 2007 were reviewed. Repeat procedures in duplicate patients were excluded. Longer term outcomes included New York Heart Association (NYHA) functional class, 6-min walking distance and invasive haemodynamics.A total of 28 patients were identified as having undergone major (57%) or minor surgery under general (50%) and regional anaesthesia. At the time of surgery, 75% of patients were in NYHA functional class I-II. Perioperative deaths occurred in 7%. Perioperative complications, all related to pulmonary hypertension, occurred in 29% of all patients and in 17% of those with no deaths during scheduled procedures. Most (n511, 92%) of the complications occurred in the first 48 h following surgery. In emergencies (n54), perioperative complication and death rates were higher (100 and 50%, respectively; p,0.005). Risk factors for complications were greater for emergency surgery (p,0.001), major surgery (p50.008) and a long operative time (193 versus 112 min; p50.003). No significant clinical or haemodynamic deterioration was seen in survivors at 3-6 or 12 months of post-operative follow-up.Despite optimal management in this mostly nonsevere pulmonary hypertension population, perioperative complications were common, although survivors remained stable. Emergency procedures, major surgery and long operations were associated with increased risk.

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Section: Discussionmentioning

confidence: 61%

mentioning

confidence: 99%

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Price¹,

Montani²,

Jaïs³

et al. 2009

Eur Respir J

121

View full text Add to dashboard Cite

show abstract

“…Moderate CO 2 elevations predictably increase pulmonary vascular resistance and pulmonary artery pressure, but also increase right ventricular performance and cardiac index secondary to sympathetic stimulation. 39,40 Caution is required in patients with significant right ventricular dysfunction or depressed adrenergic state, particularly with a more pronounced hypercapnia (PaCO 2 [70 mmHg). PaCO 2 levels as high as 70-135 mmHg have been observed during OLV and were shown to be associated with ventricular arrhythmias, oxygenation difficulties, and frequently the need for inotropic support.…”

Section: Recruitmentmentioning

confidence: 99%

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

Brassard

Lohser

Donati

et al. 2014

Can J Anesth/J Can Anesth

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“…Low tidal volumes (4-6 mL/kg IBW) have shown to reduce the risk of lung injury after thoracotomy [38] as well as permissive hypercapnia, which is thought to improve oxygenation by increasing hypoxic pulmonary vasoconstriction and, consequently, reducing shunt volume [39] .…”

Section: Avoiding Ventilation Associated Lung Injurymentioning

confidence: 99%

Pulmonary complications after spine surgery

Stundner¹

2012

WJO

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Spine surgery is one of the fastest growing branches of orthopedic surgery. Patients often present with a relatively high acuity and, depending on surgical approach, morbidity and mortality can be comparatively high. Among the most prevalent and most frequently fatalitybound perioperative complications are those affecting the pulmonary system; evidence of clinical or subclinical lung injury triggered by spine surgical procedures is emerging. Increasing burden of comorbidity among the patient population further increases the likelihood of adverse outcome. This review is intended to give an overview over some of the most important causes of pulmonary complications after spine surgery, their pathophysiology and possible ways to reduce harm associated with those conditions. We discuss factors surrounding surgical trauma, timing of surgery, bone marrow and debris embolization, transfusion associated lung injury, and ventilator associated lung injury.

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Human pulmonary vascular response to 4 h of hypercapnia and hypocapnia measured using Doppler echocardiography

Abstract: . Human pulmonary vascular response to 4 h of hypercapnia and hypocapnia measured using Doppler echocardiography. J Appl Physiol

Cited by 155 publications

References 20 publications

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Noncardiothoracic nonobstetric surgery in mild-to-moderate pulmonary hypertension

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

Pulmonary complications after spine surgery

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