Effects of Dobutamine on Right Ventricular Function and Pulmonary Circulation in Pulmonary Hypertension During Liver Transplantation

Acosta, F; Sansano, T; Palenciano, C.G; Falcon, L.; Doménech, Pedro; Robles, R; Bueno, F.S; Ramı́rez, Pablo; Parrilla, Pascual

doi:10.1016/j.transproceed.2005.10.045

Cited by 28 publications

(14 citation statements)

References 5 publications

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“…(73,85). Dobutamine has been shown to improve hemodynamics in patients with pulmonary hypertension at liver transplantation and after RV infarction (86,87). Higher doses should be avoided because of the risk of b 2 -mediated vasodilatation and hypotension (32).…”

Section: Focused Reviewmentioning

confidence: 99%

Management of Acute Right Ventricular Failure in the Intensive Care Unit

2014

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Right ventricular (RV) failure occurs when the RV fails to maintain enough blood flow through the pulmonary circulation to achieve adequate left ventricular filling. This can occur suddenly in a previously healthy heart due to massive pulmonary embolism or right-sided myocardial infarction, but many cases encountered in the intensive care unit involve worsening of compensated RV failure in the setting of chronic heart and lung disease. Management of RV failure is directed at optimizing right-sided filling pressures and reducing afterload. Due to a lower level of vascular tone, vasoactive medications have less salient effects on reducing vascular resistance in the pulmonary than in the systemic circulation. Successful management requires reversal of any conditions that heighten pulmonary vascular tone and the use of selective pulmonary vasodilators at doses that do not induce systemic hypotension or worsening of oxygenation. Systemic systolic arterial pressure should be kept close to RV systolic pressure to maintain RV perfusion. When these efforts fail, the judicious use of inotropic agents may help improve RV contractility enough to maintain cardiac output. Extracorporeal life support is increasingly being used to support patients with acute RV failure who fail to respond to medical management while the underlying cause of their RV failure is addressed.

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Section: Focused Reviewmentioning

confidence: 99%

Management of Acute Right Ventricular Failure in the Intensive Care Unit

2014

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“…Clavicle fractures have shown a strong correlation with younger age, as seen in Nordqvist and Petersson's early study, with the highest incidence seen in the under 20 year-old age group [ 11 ] . Injuries to the clavicle occur most commonly in the shaft and are sustained due to a direct force applied to the point of the shoulder during sports [ 1 ] . The present study also indicated that the groups with persons aged 10-19 years and those aged 0-9 years had the highest incidence of clavicle fracture.…”

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confidence: 99%

Incidence of Clavicle Fractures in Sports: Analysis of the NEISS Database

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Int J Sports Med

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Our goal was to present current data on the incidence of clavicle injuries presenting for urgent evaluation and to report the sports activities associated with injury. Using the National Electronic Injury Surveillance System (NEISS) database, the number of clavicle fractures presenting to a representative sample of U.S. hospitals was retrospectively calculated and weighted estimates used to extrapolate this data to the U.S. population. Incidence estimates were obtained using validated analyses and U.S. census data, with sports injuries being noted and fractures stratified by sport. A total of 9 428 fractures of the clavicle were reported, representing 357,155 injuries in the U.S. population over 5 years. The estimated incidence of clavicle fractures in the U.S. presenting for emergency care is 24.4 fractures per 100,000 person-years (95% confidence intervals (CI), 22.8-26.1). The peak incidence was highest between ages 10-19 years. Men were nearly 3 times as likely to sustain a clavicle fracture. Sports were a factor in 45% of all clavicle fractures. In sports-related injuries, 16% of fractures occurred from bicycling, followed by football (12%) and soccer (6%). In summary, injuries from bicycling were the most common cause of clavicle fracture, followed by contact sports. Male gender and younger age are risk factors for clavicle fractures.

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“…Several clinical studies have demonstrated the efficacy of dobutamine in adult patients with PH. [253][254][255] Likewise, milrinone, a PDE3 inhibitor and inodilator that augments ventricular contractility while decreasing PVR and systemic vascular resistance, improves right-ventricular output in adult patients with PH. [256][257][258] The decrease in systemic vascular resistance may not be desirable and thus may need to be addressed by the addition of a vasopressor.…”

Section: Support Of Right-ventricular Functionmentioning

confidence: 99%

Advances in the Management of Pediatric Pulmonary Hypertension

2011

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Pulmonary hypertension is a rare disease in neonates, infants, and children, and is associated with substantial morbidity and mortality. An adequate understanding of the controlling pathophysiologic mechanisms is lacking. Moreover, a minority of research is focused specifically on neonatal and pediatric populations. Although therapeutic options have increased over the past several decades, they remain limited. In advanced pulmonary hypertension, progressive pulmonary vascular functional and structural changes ultimately cause increased pulmonary vascular impedance, rightventricular failure, and death. Management includes the prevention and/or treatment of active pulmonary vasoconstriction, the support of right-ventricle function, treatment of the underlying disease (if possible), and the promotion of regressive remodeling of structural pulmonary vascular changes. Most currently available therapies augment or inhibit factors, or mediators of their downstream signaling cascades, that originate in the pulmonary vascular endothelium. These pathways include nitric-oxide/cyclic guanosine monophosphate (cGMP), prostacyclin, and endothelin-1. The ability to reverse advanced structural changes remains an as yet unattained goal. This paper reviews the epidemiology, pathophysiology, current treatments, and emerging therapies related to neonatal and pediatric pulmonary hypertension.

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Effects of Dobutamine on Right Ventricular Function and Pulmonary Circulation in Pulmonary Hypertension During Liver Transplantation

Cited by 28 publications

References 5 publications

Management of Acute Right Ventricular Failure in the Intensive Care Unit

Management of Acute Right Ventricular Failure in the Intensive Care Unit

Incidence of Clavicle Fractures in Sports: Analysis of the NEISS Database

Advances in the Management of Pediatric Pulmonary Hypertension

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