Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting

Gupta, Bhavna; Kerai, Sukhyanti; Kakkar, Kamna; Gupta, Lalit

doi:10.5005/jp-journals-10071-23264

Cited by 8 publications

(8 citation statements)

References 10 publications

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“…HFNC is a recent noninvasive technique that provides heated and humidified gas. HFNC was applied to patients with pulmonary arterial hypertension to avoid hypoxia and hypercarbia, thereby decreasing the need for intubation[ 16 ]. In this case, HFNC with 0.95% FiO2 was performed, and the intraoperative vital signs were stable.…”

Section: Discussionmentioning

confidence: 99%

Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome: A case report

Ri¹,

Jeon²

2022

WJCC

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BACKGROUND Eisenmenger syndrome (ES) is an uncorrected congenital cardiac defect with a left-to-right shunt, leading to pulmonary arterial hypertension. Patients with ES are susceptible to hemodynamic alterations during noncardiac surgery with general anesthesia, which increases perioperative morbidity and mortality. Monitored anesthesia care (MAC) is often used during minor procedures in patients with cardiac disease. However, few reports on MAC in patients with ES exist. CASE SUMMARY A 49-year-old man was admitted for a severe headache lasting 30 d. He had been diagnosed with a large perimembranous ventricular septal defect (VSD) with bidirectional shunt flow and pulmonary arterial hypertension 10 years ago. A round mass in the right frontal lobe was revealed by Magnetic resonance imaging. Stereotactic aspiration using a neuronavigation system was performed under MAC. The patient was stayed in the hospital for 5 d, and discharged without complications. CONCLUSION MAC may be effective for craniotomy in patients with ES.

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Section: Discussionmentioning

confidence: 99%

Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome: A case report

Ri¹,

Jeon²

2022

WJCC

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“…These observations may suggest that PEEP should be carefully balanced alongside adequate ventilation to avoid potential increases in PVR and further RV dysfunction. 34 Unfortunately, it was not possible to gather PVR data in this retrospective analysis; thus, future studies would benefit from also monitoring dynamic PVR changes relative to ventilatory adjustments.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

Hong

Toppen

Lee

et al. 2022

J Intensive Care Med

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Background: Emergent endotracheal intubations (ETI) in pulmonary hypertension (PH) patients are associated with increased mortality. Post-intubation interventions that could increase survivability in this population have not been explored. We evaluate early clinical characteristics and complications following emergent endotracheal intubation and seek predictors of adverse outcomes during this post-intubation period. Methods: Retrospective cohort analysis of adult patients with groups 1 and 3 PH who underwent emergent intubation between 2005-2021 in medical and liver transplant ICUs at a tertiary medical center. PH patients were compared to non-PH patients, matched by Charlson Comorbidity Index. Primary outcomes were 24-h post-intubation and inpatient mortalities. Various 24-h post-intubation secondary outcomes were compared between PH and control cohorts. Results: We identified 48 PH and 110 non-PH patients. Pulmonary hypertension was not associated with increased 24-h mortality (OR 1.32, 95%CI 0.35-4.94, P = .18), but was associated with inpatient mortality (OR 4.03, 95%CI 1.29-12.5, P = .016) after intubation. Within 24 h post-intubation, PH patients experienced more frequent acute kidney injury (43.5% vs. 19.8%, P = .006) and required higher norepinephrine dosing equivalents (6.90 [0.13-10.6] mcg/kg/min, vs. 0.20 [0.10-2.03] mcg/kg/min, P = .037). Additionally, the median P/F ratio (PaO2/FiO2) was lower in PH patients (96.3 [58.9-201] vs. 233 [146-346] in non-PH, P = .001). Finally, a post-intubation increase in PaCO2 was associated with mortality in the PH cohort (post-intubation change in PaCO2 +5.14 ± 16.1 in non-survivors vs. −18.7 ± 28.0 in survivors, P = .007). Conclusions: Pulmonary hypertension was associated with worse outcomes after emergent endotracheal intubation than similar patients without PH. More importantly, our data suggest that the first 24 hours following intubation in the PH group represent a particularly vulnerable period that may determine long-term outcomes. Early post-intubation interventions may be key to improving survival in this population.

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“…In non-intubated patients, careful application of non-invasive ventilation (NIV) with titration of PEEP to gas exchange and hemodynamics can help delay intubation and enable the treatment of underlying causes. Another potentially promising alternative to intubation is the use of high-flow nasal cannula (HFNC) which enables optimization of oxygenation with often superior patient tolerance and less cardiovascular sequelae compared to NIV [58]. -Increased intrathoracic pressure: in the mechanically ventilated patient, care must be taken to minimize intrathoracic pressures (plateau < 27 mmHg [59]) and tidal volumes.…”

Section: Immediate Measures To Break Out Of the Spiral Of Rv Failurementioning

confidence: 99%

The Right Ventricle—You May Forget It, But It Will Not Forget You

Wanner

Filipovic

2020

JCM

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Right ventricular (RV) dysfunction and failure are common and often overlooked causes of perioperative deterioration and adverse outcomes. Due to its unique pathophysiologic underpinnings, RV failure often does not respond to typical therapeutic measures such as volume resuscitation and often worsens when therapy is escalated and mechanical ventilation is begun, with a danger of irreversible cardiovascular collapse and death. The single most important factor in improving outcomes in the context of RV failure is anticipating and recognizing it. Once established, a vicious circle of systemic hypotension, and RV ischemia and dilation is set in motion, rapidly spiraling down into a state of shock culminating in multi-organ failure and ultimately death. Therapy of RV failure must focus on rapidly reestablishing RV coronary perfusion, lowering pulmonary vascular resistance and optimizing volemia. In parallel, underlying reversible causes should be sought and if possible treated. In all stages of diagnostics and therapy, echocardiography plays a central role. In severe cases of RV dysfunction there remains a role for the use of the pulmonary artery catheter. When these mostly simple measures are undertaken in a timely fashion, the spiral of death of RV failure can often be broken or even prevented altogether.

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Role of High-flow Nasal Oxygen Therapy in Cases with Pulmonary Hypertension in an Intensive Care Unit Setting

Cited by 8 publications

References 10 publications

Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome: A case report

Monitored anesthesia care for craniotomy in a patient with Eisenmenger syndrome: A case report

Outcomes and Prognostic Factors of Pulmonary Hypertension Patients Undergoing Emergent Endotracheal Intubation

The Right Ventricle—You May Forget It, But It Will Not Forget You

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