Pharmacological Interventions in Acute Respiratory Failure

  • J. L. Vincent
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 2)


The potential contribution of right ventricular (RV) dysfunction to acute cardiovascular failure has been increasingly recognized in recent years. Undoubtedly, the availability of more reliable methods of investigation has facilitated the recognition of RV dysfunction. As developed in other chapters, RV failure in acute respiratory insufficiency is principally due to increased afterload caused by pulmonary hypertension. When the right ventricle fails, RV size tends to enlarge to maintain stroke volume by increasing RV preload, but this compensatory mechanism can become insufficient and even deleterious in terms of the myocardial oxygen/supply relationship. Pulmonary hypertension can be associated with decreased RV contractility which is probably due to RV subendocardial ischemia [1]. Since acute conditions are characterized by elevated tissue oxygen needs requiring a high oxygen transport, the pulmonary hypertension associated with respiratory failure is likely to contribute to morbidity and mortality in the critically ill [1, 2].


Pulmonary Hypertension Right Ventricular Pulmonary Artery Pressure Acute Respiratory Failure Right Ventricular Function 
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  1. 1.
    Sibbald WJ, Driedger AA (1983) Right ventricular function in acute disease states: pathophysiologic considerations. Crit Care Med 11:339–345PubMedCrossRefGoogle Scholar
  2. 2.
    Zapol WM, Snider MP (1977) Pulmonary hypertension in acute respiratory failure. N Engl J Med 296:476–480PubMedCrossRefGoogle Scholar
  3. 3.
    Colucci WS, Holman BL, Wynne J, et al (1981) Improved right ventricular function and reduced pulmonary vascular resistance during prazosin therapy of congestive heart failure. Am J Med 71:75–79PubMedCrossRefGoogle Scholar
  4. 4.
    Pearl RG, Rosenthal MH, Asthon J PA (1983) Pulmonary vasodilator effects of nitroglycerin and sodium nitroprusside in canine oleic acid-induced pulmonary hypertension. Anesthesiology 58:514–518PubMedCrossRefGoogle Scholar
  5. 5.
    Lowensohn HS, Khouri EM, Gregg DE, Pyle RL, Patterson RE (1976) Phasic right coronary artery blood flow in conscious dogs with normal and elevated right ventricular pressures. Circ Res 39:760–766PubMedGoogle Scholar
  6. 6.
    Vlahakes GJ, Turley K, Hoffman JIE (1977) The pathophysiology of failure in acute right ventricular hypertension: Hemodynamic and biochemical considerations. Circulation 63:87–95CrossRefGoogle Scholar
  7. 7.
    Vincent JL, Goldstein J, Dufaye P, Domb M (1984) Electromechanical dissociation after ventricular fibrillation: Prevention with calcium-entry blockers. J Cardiovasc Pharmacol 6:1124–1131PubMedGoogle Scholar
  8. 8.
    Rubin LJ, Moser K (1986) Long-term effects of nitrendipine on hemodynamics and oxygen transport in patients with cor pulmonale. Chest 89:141–145PubMedCrossRefGoogle Scholar
  9. 9.
    Muramoto A, Caldwell J, Albert RK, Lakshminarayan S, Butler J (1985) Nifedipine dilates the pulmonary vasculature without producing symptomatic systemic hypotension in upright resting and exercising patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease. Am Rev Respir Dis 132:963–966PubMedGoogle Scholar
  10. 10.
    Stanbrook HS, Morris KG, Mc Murtry IF (1984) Prevention and reversal of hypoxic pulmonary hypertension by calcium antagonists. Am Rev Respir Dis 130:81–85PubMedGoogle Scholar
  11. 11.
    Rubin LJ, Handel F, Peter RH (1982) The effects of oral hydralazine on right ventricular end-diastolic pressure in patients with right ventricular failure. Circulation 65:1369–1374PubMedCrossRefGoogle Scholar
  12. 12.
    Brent BN, Berger HJ, Matthay RA, Mahler D, Pytlik L, Zaret BL (1983) Contrasting effects of vasodilators (nitroglycerin, nitroprusside, and hydralazine) on right ventricular performance in patients with chronic obstructive pulmonary disease and pulmonary hypertension: A combined radionuclide-hemodynamic study. Am J Cardiol 51:1682–89PubMedCrossRefGoogle Scholar
  13. 13.
    Keller CA, Shepard JW, Chun DS, Dolan GF, Vasquez P, Minh VD (1984) Effects of hydralazine on hemodynamics ventilation and gas exchange in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am Rev Respir Dis 130:606–611PubMedGoogle Scholar
  14. 14.
    Ghignone M, Girling L, Prewitt RM (1985) Effects of vasodilators on canine cardiopulmonary function when a decrease in cardiac output complicates an increase in right ventricular afterload. Am Rev Respir Dis 131:527–530PubMedGoogle Scholar
  15. 15.
    Halperin JL, Brooks KM, Rothlauf EB, Mindich BP, Ambrose JA, Teichholz LE (1985) Effect of nitroglycerin on the pulmonary venous gradient in patients after mitral valve replacement. J Am Coll Cardiol 5:34–39PubMedCrossRefGoogle Scholar
  16. 16.
    Sibbald WJ, Short AIK, Driedger AA, Wells GA (1985) The immediate effects of isosorbide dinitrate on right ventricular function in patients with acute hypoxemic respiratory failure. Am Rev Respir Dis 131:862–868PubMedGoogle Scholar
  17. 17.
    Vincent JL, Degaute JP, Domb M, Simon P, Berré J, Vandesteene A (1984) Ketanserin, a serotonin antagonist: Administration in patients with acute respiratory failure. Chest 85:510–513PubMedCrossRefGoogle Scholar
  18. 18.
    Huval WV, Lelcuk S, Shepro D, Hechtman HB (1984) Role of serotonin in patients with acute respiratory failure. Ann Surg 200:166–172PubMedCrossRefGoogle Scholar
  19. 19.
    Packer M, Medina N, Yushak M, Lee WH (1985) Comparative effects of Captopril and isosorbide dinitrate on pulmonary arteriolar resistance and right ventricular function in patients with severe left ventricular failure: Results of a randomized crossover study. Am Heart J 109:1293–1299PubMedCrossRefGoogle Scholar
  20. 20.
    Naeije R, Melot C, Mols P, Hallemans R (1982) Reduction in pulmonary hypertension by prostaglandin E1 in decompensated chronic obstructive pulmonary disease. Am Rev Respir Dis 125:1–5PubMedGoogle Scholar
  21. 21.
    Holcroft JW, Vassar MJ, Weber CJ (1986) Prostaglandin E1 and survival in patients with the adult respiratory distress syndrome: A prospective trial. Ann Surg 203:371–378PubMedCrossRefGoogle Scholar
  22. 22.
    Brent BN, Mahler D, Berger HJ, Matthay RA, Pytlik L, Zaret BL (1982) Augmentation of right ventricular performance in chronic obstructive pulmonary disease by terbutaline: A combined radionuclide and hemodynamic study. Am J Cardiol 50:313–319PubMedCrossRefGoogle Scholar
  23. 23.
    Jones RM, Stockley RA, Bishop JM (1982) Early effects of intravenous terbutaline on cardiopulmonary function in chronic obstructive bronchitis and pulmonary hypertension. Thorax 37:746–750PubMedCrossRefGoogle Scholar
  24. 24.
    Dissesa V, Brown E, Mudge GH Jr, Collins JJ Jr, Cohn LH (1982) Hemodynamic comparison of dopamine and dobutamine in the postoperative volume-loaded, pressure-loaded, and normal ventricle. J Thor Cardiovasc Surg 83:256–263Google Scholar
  25. 25.
    Reuse C, Vincent JL, Lejeune P, Kahn RJ (1986) Comparative effects of dopamine and dobutamine on right ventricular function in critically ill patients (abstract). Crit Care Med 14:385CrossRefGoogle Scholar
  26. 26.
    Molloy DW, Ducas J, Dobson K, Girling L, Prewitt RM (1986) Hemodynamic management in clinical acute hypoxemic respiratory failure: Dopamine vs dobutamine. Chest 89:636–640PubMedCrossRefGoogle Scholar
  27. 27.
    Martyn J, Wilson RS, Burke JF (1986) Right ventricular function and pulmonary hemodynamics during dopamine infusion in burned patients. Chest 89:357–360PubMedCrossRefGoogle Scholar
  28. 28.
    Ghignone M, Girling L, Prewitt RW (1984) Volume expansion versus norepinephrine in treatment of low cardiac output complicating an acute increase in right ventricular afterload in dogs. Anesthesiology 60:132–135PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1987

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  • J. L. Vincent

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