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Invasive Hemodynamic Monitoring of Aortic and Pulmonary Artery Hemodynamics in a Large Animal Model of ARDS
Published on: November 26, 2018
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Pulmonary vascular dysfunction in ARDS.
Donal Ryan1, Stephen Frohlich1, Paul McLoughlin2
1Department of Anaesthesia and Intensive Care Medicine, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
Annals of Intensive Care
|January 17, 2015
Summary
Pulmonary hypertension in acute respiratory distress syndrome (ARDS) is complex. Elevated pulmonary vascular resistance and transpulmonary gradient may indicate increased mortality risk in ARDS patients.
Area of Science:
- Critical Care Medicine
- Pulmonary Medicine
- Cardiovascular Physiology
Background:
- Acute respiratory distress syndrome (ARDS) often involves pulmonary hypertension (PH).
- Multiple factors contribute to PH development in ARDS.
- Pulmonary haemodynamics are crucial in ARDS management and prognosis.
Purpose of the Study:
- To systematically review literature on pulmonary haemodynamics and mortality in ARDS (1977-2010).
- To explore discrepancies in reported associations between pulmonary haemodynamics and mortality.
- To discuss the influence of mechanical ventilation and other factors on pulmonary arterial pressure and resistance.
Main Methods:
- Systematic literature search for studies measuring pulmonary haemodynamics and mortality in ARDS.
- Review of physiological concepts of pulmonary haemodynamics.
- Analysis of factors influencing pulmonary arterial pressure, pulmonary vascular resistance (PVR), and transpulmonary gradient (TPG).
Main Results:
- Significant variability exists in reported associations between elevated pulmonary haemodynamics (pulmonary arterial pressure, PVR) and mortality in ARDS.
- Some studies show strong associations, while others find none.
- Bull et al. (2010) uniquely reported PVR and TPG independently associated with increased mortality in ARDS with lung-protective ventilation.
Conclusions:
- Abnormally elevated PVR/TPG may serve as an index of ARDS severity and progression.
- Existing evidence does not confirm a causal relationship between PVR/TPG and ARDS mortality.
- Further research is needed to clarify the role of pulmonary vascular dysfunction in ARDS, especially with lung-protective ventilation.
Keywords:
ARDSAcute cor pulmonaleOutcomePulmonary haemodynamicsPulmonary vascular dysfunctionPulmonary vascular resistanceMore Related Videos
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