Pulmonary hypertension in critical care

被引:23
作者
Gayat, Etienne [1 ,2 ]
Mebazaa, Alexandre [1 ,3 ]
机构
[1] Univ Paris 07, Dept Anesthesiol & Intens Care, Lariboisiere Univ Hosp, Assistance Publ Hop Paris, Paris, France
[2] INSERM, U717, Paris, France
[3] INSERM, U942, Paris, France
关键词
acute cor pulmonale; acute respiratory distress syndrome; intensive care; pulmonary hypertension; RESPIRATORY-DISTRESS-SYNDROME; ACUTE COR-PULMONALE; RIGHT-VENTRICULAR-FUNCTION; INHALED NITRIC-OXIDE; CARDIAC TROPONIN-I; ARTERY CATHETER; HEMODYNAMIC EVALUATION; MANAGEMENT STRATEGIES; CLINICAL IMPLICATIONS; NATRIURETIC PEPTIDE;
D O I
10.1097/MCC.0b013e32834a7619
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Purpose of review To review the contemporary management of patients with pulmonary hypertension in critical care. Recent findings The normal mean pulmonary artery pressure (mPAP) at rest is 14 +/- 3 mmHg and pulmonary hypertension is considered when mPAP is greater than or equal to 25 mmHg at rest. The classification of pulmonary hypertension has been redefined recently and updated in 2009 and could help to guide the management of patients with pulmonary hypertension in critical care. The management of pulmonary hypertension in ICU is based on expert opinion. Among the diagnostic and monitoring tools available, echocardiography provides useful information noninvasively, although pulmonary artery catheter must be used in case of complicated situations. Calcium sensitizers, a new class of inotrope, have inotropic effects and induce dilatation of the pulmonary, systemic, and coronary vasculature and thus could be useful in case of right ventricular failure (RVF), particularly in patients with acute respiratory distress syndrome (ARDS). By increasing the pulmonary vasodilator response to inhaled nitric oxide and preventing the rebound pulmonary vasoconstriction which occurs following cessation of nitric oxide breathing, selective type 5 isoform of phosphodiesterase inhibitors could be useful in critically ill patients. Summary This article reviews recent and key findings on the management of pulmonary hypertension in critically ill patients.
引用
收藏
页码:439 / 448
页数:10
相关论文
共 58 条
[1]  
*AC RESP DISTR SYN, 2000, NEW ENGL J MED, V342, P1301, DOI DOI 10.1056/NEJM200005043421801
[2]   Diagnosis and Assessment of Pulmonary Arterial Hypertension [J].
Badesch, David B. ;
Champion, Hunter C. ;
Gomez Sanchez, Miguel Angel ;
Hoeper, Marius M. ;
Loyd, James E. ;
Manes, Alessandra ;
McGoon, Michael ;
Naeije, Robert ;
Olschewski, Horst ;
Oudiz, Ronald J. ;
Torbicki, Adam .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (01) :S55-S66
[3]   Tadalafil monotherapy and as add-on to background bosentan in patients with pulmonary arterial hypertension [J].
Barst, Robyn J. ;
Oudiz, Ronald J. ;
Beardsworth, Anthony ;
Brundage, Bruce H. ;
Simonneau, Gerald ;
Ghofrani, Hossein A. ;
Sundin, David P. ;
Galie, Nazzareno .
JOURNAL OF HEART AND LUNG TRANSPLANTATION, 2011, 30 (06) :632-643
[4]   Updated Evidence-Based Treatment Algorithm in Pulmonary Arterial Hypertension [J].
Barst, Robyn J. ;
Gibbs, J. Simon R. ;
Ghofrani, Hossein A. ;
Hoeper, Marius M. ;
McLaughlin, Vallerie V. ;
Rubin, Lewis J. ;
Sitbon, Olivier ;
Tapson, Victor F. ;
Galie, Nazzareno .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (01) :S78-S84
[5]   Antithrombotic therapy for venous thromboembolic disease [J].
Büller, HR ;
Agnelli, G ;
Hull, RD ;
Hyers, TA ;
Prins, AH ;
Raskob, GE .
CHEST, 2004, 126 (03) :401S-428S
[6]   Haemodynamic evaluation of pulmonary hypertension [J].
Chemla, D ;
Castelain, V ;
Hervé, P ;
Lecarpentier, Y ;
Brimioulle, S .
EUROPEAN RESPIRATORY JOURNAL, 2002, 20 (05) :1314-1331
[7]   The incidence and pathogenesis of cardiopulmonary deterioration after abrupt withdrawal of inhaled nitric oxide [J].
Christenson, J ;
Lavoie, A ;
O'Connor, M ;
Bhorade, S ;
Pohlman, A ;
Hall, JB .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 161 (05) :1443-1449
[8]   The effectiveness of right heart catheterization in the initial care of critically ill patients [J].
Connors, AF ;
Speroff, T ;
Dawson, NV ;
Thomas, C ;
Harrell, FE ;
Wagner, D ;
Desbiens, N ;
Goldman, L ;
Wu, AW ;
Califf, RM ;
Fulkerson, WJ ;
Vidaillet, H ;
Broste, S ;
Bellamy, P ;
Lynn, J ;
Knaus, WA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (11) :889-897
[9]   Impact of acute hypercapnia and augmented positive end-expiratory pressure on right ventricle function in severe acute respiratory distress syndrome [J].
Dessap, Armand Mekontso ;
Charron, Cyril ;
Devaquet, Jerome ;
Aboab, Jerome ;
Jardin, Francois ;
Brochard, Laurent ;
Vieillard-Baron, Antoine .
INTENSIVE CARE MEDICINE, 2009, 35 (11) :1850-1858
[10]   Combined clot fragmentation and aspiration in patients with acute pulmonary embolism [J].
Eid-Lidt, Guering ;
Gaspar, Jorge ;
Sandoval, Julio ;
Damas de los Santos, Felix ;
Pulido, Tomas ;
Gonzalez Pacheco, Hector ;
Martinez-Sanchez, Carlos .
CHEST, 2008, 134 (01) :54-60