Pulmonary hypertension with adult respiratory distress syndrome: prevalence, clinical impact, and association with central venous pressure

Li, Dongkai; Mao, Jianshan; Long, Yun; Liu, Dawei; Wang, Xiaoting

doi:10.1177/2045894020933087

Cited by 9 publications

(8 citation statements)

References 24 publications

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“…Although RV dysfunction has been described in patients with acute respiratory distress syndrome (ARDS), the prevalence of RV dysfunction in our study is higher than what has been reported in non-COVID-19 patients with ARDS. [27][28][29] It is possible that RV dysfunction associated with COVID-19 may be pathologically distinct for several reasons. First, macroand microvascular thrombosis from deranged coagulation pathways could induce RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series

Honarmand¹,

Fiorini²,

Chakraborty³

et al. 2022

cmajo

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series

Honarmand¹,

Fiorini²,

Chakraborty³

et al. 2022

cmajo

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“…Splitting patients into a derivation and validation cohort, they identified four variables: pneumonia as a cause of ARDS, driving pressure ≥ 18 cm H 2 O, arterial oxygen partial pressure to fractional inspired oxygen (PaO 2 /FiO 2 ) ratio < 150 mmHg and arterial carbon dioxide partial pressure ≥ 48 mmHg, which comprised the ACP risk score. The ACP risk score was subsequently validated by Li et al [ 17 ] in a retrospective analysis of 2434 patients. Additionally, the ACP score correlated with an increased incidence of pulmonary hypertension in patients with ARDS, with each increase in ACP score associated with an increase in the prevalence of pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

Mechanical ventilation variables associated with high pulmonary artery pressures in ARDS patients: a post hoc analysis

et al. 2022

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Background The relationship between indices of mechanical ventilation and pulmonary artery pressures remains ill-defined in ARDS. As our understanding of mechanical ventilation has progressed, there is now a greater appreciation of the impact of high driving pressures and mechanical power in perpetuating lung injury. However, the relationship between the newer derived indices of mechanical ventilation and pulmonary artery pressure is unclear. We performed a post hoc analysis of the Fluid and Catheters Treatment Trial (FACTT) trial to investigate the associations between mechanical ventilation indices in ARDS patients and the prevalence of pulmonary hypertension. This may help elucidate future clinical targets for more, right ventricular protective, mechanical ventilation strategies. Methods We performed a post hoc analysis of the FACTT database to identify ARDS patients who had a pulmonary artery catheter (PAC) inserted and pulmonary artery pressure readings recorded. We excluded any patient with a PAC inserted who was spontaneously breathing, as driving pressure and mechanical power are not validated in this cohort. Three independent analyses were performed: a univariate analysis, to assess for associations between mPAP and mechanical ventilation parameters using Pearson correlation coefficients, a multivariate analysis, to assess for independent associations with mPAP using a multiple regression model according to Akaike’s information criteria and finally an analysis for nonlinearity, using the best-fitting model according to the Bayesian information criterion (BIC) from linear, quadratic, fractional polynomial and restricted cubic spline models. Results All the ventilation parameters demonstrated a significant correlation with mPAP, except tidal volume (once adjusted for respiratory rate) in the univariate analysis. The multivariate analysis demonstrated that the blood pH level, P/F ratio, PaCO2 level, mean airway pressure and the mechanical power indexed to compliance were independently associated with mPAP. In the final nonlinear analysis, associations did not differ from linearity except for 4 variables for which the fractional polynomial was the best-fitting model. These were mechanical power (p = 0.01 compared to the linear model), respiratory rate (p = 0.04), peak pressure (p = 0.03) and mean airway pressure (p = 0.01). Two nonlinear variables associated with mPAP were assessed in more detail, respiratory rate and mechanical power. Inflexion points at a respiratory rate of 16.8 cycles per minute and a mechanical power of 8.8 J/min were demonstrated. Conclusions The associations identified between mPAP and mechanical ventilation variables in this analysis would suggest that classical ARDS lung protective strategies, including low tidal volume ventilation and permissive hypercapnia, may negatively impact the management of the subset of ARDS patients with associated right ventricular dysfunction or ACP. Additionally, respiratory rates above 17 cycles per minute show an incremental increase in mPAP. Therefore, increases in tidal volume (within the limitation of driving pressure < 18 cmH20) may represent a more right ventricular protective way to control CO2 and pH.

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Section: Discussionmentioning

confidence: 99%

“…Elevated mean CVP (>12 mmHg) is independently associated with the occurrence of PH in patients with ARDS, thus highlighting the importance of CVP monitoring in the management of ARDS. 77,78 Therefore, the long-term follow-up of cardiopulmonary function for COVID-19 survivors could become a relevant health problem in the near future, given the large number of patients infected by COVID-2019 worldwide. In this context, measuring the venous congestion in a quick and practical manner by the new VenCoM device, could be extremely useful for both the management of clinical PH following COVID-19 during the acute phase, and the monitoring of pulmonary and vascular remodeling effects after recovery to provide the best long-term management of survivors.…”

Section: Vencom In Pandemic Covid-19mentioning

confidence: 99%

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

Marcelli¹,

Cercenelli²,

Bortolani³

et al. 2021

MDER

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Background Venous congestion can be quantified by central venous pressure (CVP) and its monitoring is crucial to understand and follow the hemodynamic status of patients with cardio-respiratory diseases. The standard technique for CVP measurement is invasive, requiring the insertion of a catheter into a jugular vein, with potential complications. On the other hand, the current non-invasive methods, mainly based on ultrasounds, remain operator-dependent and are unsuitable for use in the home environment. In this paper, we will introduce a novel, non-invasive device for the hospital, office and home assessment of CVP. Methods After describing the measurement concept, we will report a preliminary experimental study enrolling 5 voluntary healthy subjects to evaluate the VenCoM measurements’ repeatability, and the system’s capability in measuring small elicited venous pressure variations (2 mmHg), as well as an induced venous hypertension within a pathological range (12÷20 mmHg). Results The experimental measurements showed a repeatability of ±1mmHg. The VenCoM device was able to reliably detect the elicited venous pressure variations and the simulated congestive status. Discussion and Conclusion The proposed non-invasive VenCoM device is able to provide a fast and repeatable CVP estimate, having a wide spectrum of potential clinical applications, including the monitoring of venous congestion in heart failure patients and in subjects with renal and hepatic dysfunction, as well as pulmonary hypertension (PH) that can be extended to pneumonia COVID-19 patients even after recovery. The device needs to be tested further on a large sample size of both healthy and pathological subjects, to systematically validate its reliability and impact in clinical setting.

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Pulmonary hypertension with adult respiratory distress syndrome: prevalence, clinical impact, and association with central venous pressure

Cited by 9 publications

References 24 publications

Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series

Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series

Mechanical ventilation variables associated with high pulmonary artery pressures in ARDS patients: a post hoc analysis

A Novel Non-Invasive Device for the Assessment of Central Venous Pressure in Hospital, Office and Home

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