Mechanical ventilation in cardiogenic shock

Tavazzi, Guido

doi:10.1097/mcc.0000000000000836

Cited by 9 publications

(11 citation statements)

References 57 publications

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“…Prior to ECMO initiation, hemodynamic instability, low cardiac output [ 14 , 34 ], hypoxemia [ 35 ], inflammatory cytokines [ 36 ] and other illness-related factors [ 37 , 38 ], alone or in combination, contribute to renal dysfunction. MV is widely used in patients with cardiogenic shock for the management of acute hypoxemia, increased work of breathing, airway protection, and hemodynamic or electric instability [ 39 ]. Positive end-expiratory pressure could reduce work of and promote recovery of myocardium by decreasing venous return and left ventricular pre-load.…”

Section: Discussionmentioning

confidence: 99%

Impact of renal complications on outcome in adult patients with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation: an analysis of nationwide CSECLS database in China

Hao,

Chen,

et al. 2023

Ann. Intensive Care

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Background Limited data are available on renal complications in patients with acute fulminant myocarditis (AFM) receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) support in China. To evaluate the impact of renal complications on outcomes in adult patients with AFM supported with VA-ECMO. Methods Data were extracted from Chinese Society of ExtraCorporeal Life Support (CSECLS) Registry database. Adult patients who were diagnosed with AFM receiving VA-ECMO support in the database were included. The primary outcome was 30-day mortality in patients with AFM supported with VA-ECMO. Logistic regression model was used to examine the impact of renal complications on 30-day mortality by adjusting confounders. Results A total of 202 patients were included. The median age was 38 years (IQR 29–48) and males (n = 103) represented 51.0% of the total accounted patients. The median ECMO duration was 142.9 h (IQR 112.1–188.8 h). 178 (88.1%) patients weaned from ECMO and 156 (71.9%) patients survived. 94(46.5%) patients developed renal complications while on ECMO course. Patients with renal complications had higher 30-day mortality (40.7% (37 of 94) vs 8.3% (9 of 108), P < 0.001) compared with those without. The development of renal complications was related to a 3.12-fold increase risk of 30-day mortality (adjusted OR 3.120, 95%CI 1.002–6.577, P = 0.049). Increasing age (adjusted OR1.025, 95% CI 1.008–1.298, P = 0.040) and higher SOFA score (adjusted OR 1.162, 95%CI 1.012–1.334, P = 0.034) were independent risk factors of renal complications. Conclusions Our findings demonstrated that patients with AFM receiving VA-ECMO at high risk of developing renal complications. Advancing age and higher SOFA score was associated with increased risk of developing renal complications. The onset of renal complications was significantly associated with 30-day mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of renal complications on outcome in adult patients with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation: an analysis of nationwide CSECLS database in China

Hao,

Chen,

et al. 2023

Ann. Intensive Care

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“…Despite this, there is paucity of large-scale data regarding the best ventilatory strategy in this setting. Positive pressure ventilation (PPV), including noninvasive and mechanical ventilation, may reverse hypox-emia and reduce transmural pressure favoring myocardial and end-organ perfusion [28]. Although PPV can improve dyspnea and hypoxemia, along with their associated metabolic derangements, its influence on mortality is unclear [1].…”

Section: Additional Therapiesmentioning

confidence: 99%

“…Noninvasive-PPV [continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and high-flow nasal cannula] improves cardiogenic pulmonary edema, hypercapnia, acidosis, and reduces the need for intubation. However, adequate mentation for airway protection is a prerequisite for use of noninvasive-PPV and, ultimately, most patients with advanced stages of cardiogenic shock require invasive mechanical ventilation [1,28].…”

Section: Additional Therapiesmentioning

confidence: 99%

Role of medical management of cardiogenic shock in the era of mechanical circulatory support

Blumer

Marbach²,

Veasey

et al. 2022

Current Opinion in Cardiology

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Purpose of reviewThe goal of this review is to summarize the current knowledge on the role of medical management of cardiogenic shock in the era of mechanical circulatory support based on important lessons from clinical trials and routine clinical practice, with a focus on providing practical recommendations that can improve contemporary in-hospital management. Recent findingsDespite an increasing number of invasive therapies being used to manage cardiogenic shock, evidencebased treatment regimens known to improve outcomes are limited. Medical management of cardiogenic shock includes pharmacological interventions aimed at optimizing determinants of cardiac output-contractility, preload, afterload, and heart rate. In this regard, inotropes and vasopressors remain cornerstone therapies for the management of cardiogenic shock. Norepinephrine has shown potential vasopressor advantage with compared with dopamine, and although milrinone and dobutamine are both considered appropriate first-line inotropes, there is limited data to guide selection, and a recent randomized clinical trial found no significant differences in the treatment of cardiogenic shock.

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“…These hemodynamic changes can be ameliorated by restricting fluids, having the patients slightly hypovolemic and treating bronchospasm prior to extubation. Optimizing bronchodilation, avoiding volume overload and controlling afterload prior to weaning trials will facilitate liberation from mechanical ventilation ( Jubran et al, 1998 ; Roche-Campo et al, 2018 ; Tavazzi, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiopulmonary interactions in left heart failure

Alvarado

Pinsky

2023

Front. Physiol.

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The primary impact of ventilation and ventilatory efforts on left ventricular (LV) function in left ventricular dysfunction relate to how changes in intrathoracic pressure (ITP) alter the pressure gradients for venous return into the chest and LV ejection out of the chest. Spontaneous inspiratory efforts by decreasing ITP increase both of these pressure gradients increasing venous blood flow and impeding LV ejection resulting in increased intrathoracic blood volume. In severe heart failure states when lung compliance is reduced, or airway resistance is increased these negative swings in ITP can be exacerbated leading to LV failure and acute cardiogenic pulmonary edema. By merely reversing these negative swings in ITP by the use of non-invasive continuous positive airway pressure (CPAP), these profoundly detrimental forces can be immediately reversed, and cardiovascular stability can be restored in moments. This forms the clinical rationale for the immediate use of CPAP for the treatment of acute cardiogenic pulmonary edema. Increasing ITP during positive pressure ventilation decreases the pressure gradients for venous return and LV ejection decreasing intrathoracic blood volume. In a hypovolemic patient even with LV dysfunction this can result in hypotension due to inadequate LV preload. Minor increases in ITP as occur using pressure-limited positive-pressure ventilation primarily reverse the increased LV afterload of negative swings in ITP and if fluid overload was already present, minimally alter cardiac output. The effect of changes in lung volume on LV function are related primarily to its effects on right ventricular (RV) function through changes in pulmonary vascular resistance and overdistention (hyperinflation). In acute lung injury with alveolar collapse, positive pressure ventilation may reduce pulmonary vascular resistance if alveolar recruitment predominates. Hyperinflation, however, impedes diastolic filling while simultaneously increasing pulmonary vascular resistance. Thus, increasing lung volume can reduce RV afterload by reversing hypoxic pulmonary vasoconstriction or increase afterload by overdistention. Hyperinflation can also impede RV filling. All of these processes can be readily identified at the bedside using echocardiography.

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Mechanical ventilation in cardiogenic shock

Cited by 9 publications

References 57 publications

Impact of renal complications on outcome in adult patients with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation: an analysis of nationwide CSECLS database in China

Impact of renal complications on outcome in adult patients with acute fulminant myocarditis receiving venoarterial extracorporeal membrane oxygenation: an analysis of nationwide CSECLS database in China

Role of medical management of cardiogenic shock in the era of mechanical circulatory support

Cardiopulmonary interactions in left heart failure

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