The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: An observational study

Fuller, Brian M.; Mohr, Nicholas M.; Graetz, Thomas J.; Lynch, Isaac; Dettmer, Matthew; Cullison, Kevin; Coney, Talia; Gogineni, Swetha; Gregory, Robert

doi:10.1016/j.jcrc.2014.07.027

Cited by 16 publications

(5 citation statements)

References 56 publications

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“…Undesired side effects of the recruitment process mainly arise from the increased airway pressures which can cause overdistension of alveoli in well-ventilated lung areas, marked increase in ventilation-perfusion mismatch, barotrauma, pneumothorax, and new air leak around an existing chest tube [ 12 ]. These effects may be even more pronounced in patients with ARDS in whom haemodynamic instability is a common feature [ 13 ]. It has strong pathophysiological rationale supported by clinical data that routine ICU monitoring, such as invasive blood pressure and central venous pressure monitoring, may not be adequate to follow haemodynamic changes encountered during lung recruitment [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Haemodynamic Effects of Lung Recruitment Manoeuvres

Lovas

Szakmány

2015

BioMed Research International

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Atelectasis caused by lung injury leads to increased intrapulmonary shunt, venous admixture, and hypoxaemia. Lung recruitment manoeuvres aim to quickly reverse this scenario by applying increased airway pressures for a short period of time which meant to open the collapsed alveoli. Although the procedure can improve oxygenation, but due to the heart-lung and right and left ventricle interactions elevated intrathoracic pressures can inflict serious effects on the cardiovascular system. The purpose of this paper is to give an overview on the pathophysiological background of the heart-lung interactions and the best way to monitor these changes during lung recruitment.

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Section: Introductionmentioning

confidence: 99%

Haemodynamic Effects of Lung Recruitment Manoeuvres

Lovas

Szakmány

2015

BioMed Research International

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“…9 In a retrospective assessment of PPVS in patients with sepsis, cardiac dysfunction was not associated with either progression to ARDS or worse outcomes in ARDS. 235…”

Section: Methodsmentioning

confidence: 99%

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

Jones

Smith

Tuyl

et al. 2020

J Intensive Care Med

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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.

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“…This might be due to many associated conditions such as hepato-pulmonary syndrome, Porto-pulmonary hypertension, hepatic hydrothorax, and related hypoxemia [23]. Similarly, the patients who underwent a recent cardiovascular surgery, were more prone to develop ARDS and its further complications [25] though there is conflicting result on the impact of cardiovascular problems on mortality in ARDS patients [25][26][27].…”

Section: J O U R N a L P R E -P R O O Fmentioning

confidence: 99%

Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting

Rashid

Ramakrishnan

Muthu

et al. 2022

Clinical Epidemiology and Global Health

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The impact of cardiac dysfunction on acute respiratory distress syndrome and mortality in mechanically ventilated patients with severe sepsis and septic shock: An observational study

Cited by 16 publications

References 56 publications

Haemodynamic Effects of Lung Recruitment Manoeuvres

Haemodynamic Effects of Lung Recruitment Manoeuvres

Sepsis With Preexisting Heart Failure: Management of Confounding Clinical Features

Factors affecting the outcomes in patients with acute respiratory distress syndrome in a tertiary care setting

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