Adverse Heart–Lung Interactions in Ventilator-induced Lung Injury

Katira, Bhushan; Giesinger, Regan E.; Engelberts, Doreen; Zabini, Diana; Kornecki, Alik; Otulakowski, Gail; Yoshida, Toyohiko; Kuebler, Wolfgang M.; McNamara, Patrick J.; Connelly, Kim A.; Kavanagh, Brian P.

doi:10.1164/rccm.201611-2268oc

Cited by 62 publications

(47 citation statements)

References 46 publications

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“…around 13 mmHg, and patients had signi cant PPV. ARDS has been clearly reported as a risk factor for RV failure (13,26), while in the present cohort we did not nd a higher incidence of ARDS in these patients. However, we found a certain degree of pulmonary hypertension that could be related to an increase in BMI with a history of chronic respiratory failure.…”

Section: Rv and Sepsiscontrasting

confidence: 77%

Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness

Vieillard‐Baron

Prigent

Repessé

et al. 2020

Preprint

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Objective Incidence of right ventricular (RV) failure in septic shock patients is not well-known and Tricuspid annular plane systolic excursion (TAPSE) could be of limited value. We report the incidence of RV failure in patients with septic shock, its potential impact on the response to fluids, as well as TAPSE values.Design Ancillary study of the HEMOPRED prospective multicenter study including patients under mechanical ventilation with circulatory failure.Setting Multicenter intensive care unit studyPatients 282 with septic shock were analyzed. Patients were classified in 3 groups based on central venous pressure (CVP) and RV size (RV/LV end-diastolic area, EDA). In group 1, patients had no RV dilatation (RV/LVEDA < 0.6). In group 2, patients had RV dilatation (RV/LVEDA ≥ 0.6) with a CVP < 8 mmHg (no venous congestion). RV failure was defined in group 3 by RV dilatation and a CVP ≥ 8 mmHg. Pulse pressure variation (PPV) was systematically recorded.Interventions NoneMeasurements And main results 41% of patients were in group 1, 17% in group 2 and 42% in group 3. A correlation between RV size and CVP was only observed in group 3. Higher RV size was associated with a lower response to passive leg raising for a given PPV. A large overlap of TAPSE values was observed between the 3 groups. 63.5% of patients with RV failure had anormal TAPSE.Conclusions RV failure, defined by critical care echocardiography (RV dilatation) and a surrogate of venous congestion (CVP ≥ 8 mmHg), was frequently observed in septic shock patients and negatively associated with response to a fluid challenge despite significant PPV. TAPSE was unable to discriminate patients with or without RV failure.

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Section: Rv and Sepsiscontrasting

confidence: 77%

Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness

Vieillard‐Baron

Prigent

Repessé

et al. 2020

Preprint

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“…MV is associated with risks of ventilator-associated pneumonia, ventilator-induced lung injury, and hemodynamic instability [5][6][7][8]. Furthermore, recent reports have indicated that waiting for lung transplantation with MV support is a risk factor for increased mortality compared without MV [9,10].…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal membrane oxygenation as a bridge to lung transplantation: analysis of Korean organ transplantation registry (KOTRY) data

Lee

Kim

et al. 2020

Respir Res

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Background: The use of extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation has greatly increased. However, data regarding the clinical outcomes of this approach are lacking. The objective of this multicenter prospective observational cohort study was to evaluate lung transplantation outcomes in Korean Organ Transplantation Registry (KOTRY) patients for whom ECMO was used as a bridge to transplantation. Methods: Between March 2015 and December 2017, a total of 112 patients received lung transplantation and were registered in the KOTRY, which is a prospective, multicenter cohort registry. The entire cohort was divided into two groups: the control group (n = 85, 75.9%) and bridge-ECMO group (n = 27, 24.1%).Results: There were no significant differences in pre-transplant and intraoperative characteristics except for poorer oxygenation, more ventilator use, and longer operation time in the bridge-ECMO group. The prevalence of primary graft dysfunction at 0, 24, 48, and 72 h after transplantation did not differ between the two groups. Although postoperative hospital stays were longer in the bridge-ECMO group than in the control group, hospital mortality did not differ between the two groups (25.9% vs. 13.3%, P = 0.212). The majority of patients (70.4% of the bridge-ECMO group and 77.6% of the control group) were discharged directly to their homes. Finally, the use of ECMO as a bridge to lung transplantation did not significantly affect overall survival and graft function. Conclusions: Short-and long-term post-transplant outcomes of bridge-ECMO patients were comparable to recipients who did not receive ECMO.

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“…36 Recent data suggest that not only is the RV dysfunction the consequence of VILI, but also it could promote in part such a ventilator-induced lung injury (VILI). 37,38 The protective effect of prone positioning against VILI potentially could be explained by ventilatory homogeneity, a decrease in tidal hyperinflation, and homogenous distribution of strain. [33][34][35][36][37] In conclusion, a substantial body of evidence supports the pivotal role of prone positioning in reducing mortality outcomes in severe ARDS.…”

Section: Protection Against Ventilator-induced Lung Injurymentioning

confidence: 99%

“…37,38 The protective effect of prone positioning against VILI potentially could be explained by ventilatory homogeneity, a decrease in tidal hyperinflation, and homogenous distribution of strain. [33][34][35][36][37] In conclusion, a substantial body of evidence supports the pivotal role of prone positioning in reducing mortality outcomes in severe ARDS. RV failure is a predictor of mortality in ARDS, and therefore monitoring and protecting the RV should be made an integral part of a heart and lung protective strategy in severe ARDS.…”

Section: Protection Against Ventilator-induced Lung Injurymentioning

confidence: 99%

Protecting the Right Ventricle in ARDS: The Role of Prone Ventilation

Zochios

Parhar

Vieillard-Baron

2018

Journal of Cardiothoracic and Vascular Anesthesia

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ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) is associated with high mortality (up to 46%) despite best standards of supportive care. 1 One of the major determinants of mortality in severe ARDS is hemodynamic instability, in particular pulmonary vascular dysfunction and right ventricular (RV) dysfunction/failure 2,3 ; however, cardiopulmonary interactions in the context of ARDS are not understood fully. In most ARDS studies, RV failure is defined as "acute cor pulmonale" (ACP), which refers to an abrupt increase in RV afterload. On echocardiography, this is characterized by septal dyskinesia and RV dilatation with a ratio of RV end-diastolic area (RVEDA) to left ventricular end-diastolic area (LVEDA) 4 0.6 and 41 for severe ACP. 4,5 A recent risk score developed for the prediction of ACP in ARDS demonstrated several important clinical and physiologic parameters: (a) pneumonia as a cause of ARDS, (b) ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 / F i O 2) o150 mmHg, (c) arterial carbon dioxide partial pressure (PaCO 2) Z 48 mmHg, and (d) driving pressure Z18 cm H 2 O. 5 The aforementioned variables have a statistically significant correlation with development of ACP with a reported incidence of 19%, 34%, and 74% in ARDS patients with risk scores of 2, 3, and 4, respectively. 5

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Adverse Heart–Lung Interactions in Ventilator-induced Lung Injury

Cited by 62 publications

References 46 publications

Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness

Right ventricular failure in septic shock. Characterization, incidence and impact on fluid-responsiveness

Extracorporeal membrane oxygenation as a bridge to lung transplantation: analysis of Korean organ transplantation registry (KOTRY) data

Protecting the Right Ventricle in ARDS: The Role of Prone Ventilation

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