Advertisement

Pulmonary Hypertension in ARDS: Management Strategies

  • A. Brienza
  • N. Brienza
Conference paper

Abstract

Pulmonary hypertension (PH) is the consequence of either acute or chronic diseases resulting in the loss of the low pressure-high flow characteristics of pulmonary circulation. In 1977, Zapol and Snider demonstrated that PH is a physiological hallmark of ARDS as shown by the occurrence of a mean pulmonary arterial pressure (mPAP) > 25 mmHg in 58% of patients with severe ARF in the early phase [1]. In over 100 patients with ARDS, studied from 1–30 days after onset of symptoms, Zapol et al. observed mPAP to be around 22–28 mmHg in absence of severe hypoxemia, and in the range of 28–35 mmHg or more in presence of severe hypoxemia [2].

Keywords

Pulmonary Hypertension Right Ventricular Right Ventricular Ejection Fraction Hypoxic Pulmonary Vasoconstriction Right Ventricular Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296: 476 - 480PubMedCrossRefGoogle Scholar
  2. 2.
    Zapol WM, Snider MT, Rie MA et al (1986) Pulmonary circulation during adult pulmonary distress syndrome. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. New York, Marcel Dekker, vol 24, pp 241 - 273Google Scholar
  3. 3.
    Jones R, Reid LM, Zapol WM et al (1992) Pulmonary vascular pathology: Human and experimental studies. In: Zapol WM, Falke KJ (eds) Lung biology in health and diseases. New York, Marcel Dekker, pp 23 - 160Google Scholar
  4. 4.
    Squara P, Dhainaut JF, Artigas A et al (1998) Hemodynamic profile in severe ARDS: results of the European Collaborative ARDS study. Int Care Med 24: 1018 - 1028CrossRefGoogle Scholar
  5. 5.
    Brienza A, Cinnella G, Dambrosio M et al (1991) Incidence of pulmonary arterial hypertension and right ventricular impairment in moderate and severe acute respiratory failure. Acta Anaesthesiologica Italica 42[Suppl 11: 45 - 55Google Scholar
  6. 6.
    Dambrosio M, Fiore G, Brienza N et al (1996) Right ventricular myocardial function in ARF patients. Int Care Med 22: 772 - 780CrossRefGoogle Scholar
  7. 7.
    Brunet F, Dhainaut JF, Devaux JY et al (1988) Right ventricular performance in patients with acute respiratory failure. Int Care Med 14: 474 - 477CrossRefGoogle Scholar
  8. 8.
    Abraham AS, Cole RB, Greene ID et al (1969) Factors contributing to the reversible pulmonary hypertension in patients with acute respiratory failure studied by serial observation during recovery. Cire Res 24: 51 - 60CrossRefGoogle Scholar
  9. 9.
    Melot CP, Lejeune M, Leeman JJ et al (1989) Prostaglandin E1 in the ARDS. Benefit for pulmonary hypertension and cost for pulmonary gas exchange. Am Rev Respir Dis 139: 106-116Google Scholar
  10. 10.
    Radermacher P, Santak B, Wust J et al (1990) Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS. Int Care Med 16: 227 - 232CrossRefGoogle Scholar
  11. 11.
    Holcroft JW, Vossar MJ, Weber CJ (1986) Prostaglandin E1 and survival in patients with the adult distress syndrome. Ann Surg 203: 371 - 380PubMedCrossRefGoogle Scholar
  12. 12.
    Bone RC, Slotman G, Maunder R et al (1989) Randomized double-blind multi-centre study of prostaglandin E1 in patients with the adult respiratory distress syndrome. Chest 96: 114 - 119PubMedCrossRefGoogle Scholar
  13. 13.
    Brienza N (1998) Inhaled prostacyclin: from pulmonary hypertension to splanchnic hypoperfusion. Int Care Med 24: 1228 - 1230CrossRefGoogle Scholar
  14. 14.
    Ferreira E, Shalansky SJ (1999) Nitric oxide for ARDS - what is the evidence? Pharmacotherapy 19: 60 - 69PubMedCrossRefGoogle Scholar
  15. 15.
    Mikhail G, Gibbs JSR, Richardson M et al (1997) An evaluation of nebulized prostacyclin in patients with primary and secondary pulmonary hypertension. Eur Heart J 18: 1499 - 1504PubMedCrossRefGoogle Scholar
  16. 16.
    Zwissler B, Kemming G, Habler O et al (1996) Inhaled prostacyclin (PGI2) versus inhaled nitric oxide in Adult Respiratory Distress Syndrome. Am J Respir Crit Care Med 154: 1671 - 1677PubMedGoogle Scholar
  17. 17.
    Walmrath D, Schneider T, Schermuly R et al (1996) Direct comparison of inhaled nitric oxide and aerosolized prostacyclin in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 153: 991 - 996PubMedGoogle Scholar
  18. 18.
    Brienza N, Grasso S, Bruno F et al (1996) Effects of continuous administration of aerosolized prostacyclin on hemodynamics and gas exchange in ARDS. Int Care Med 22 (3): S427Google Scholar
  19. 19.
    Rossaint R, Slama K, Steudel Wet al (1995) Effects of inhaled nitric oxide on right ventricular function in severe acute respiratory distress syndrome. Int Care Med 21: 197 - 203CrossRefGoogle Scholar
  20. 20.
    Zwissler B, Welte M, Messmer K (1995) Effects of inhaled prostacyclin as compared with inhaled nitric oxide on right ventricular performance in hypoxic pulmonary vasoconstriction. J Cardiothor Vasc Anesth 9 (3): 283 - 289CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • A. Brienza
  • N. Brienza

There are no affiliations available

Personalised recommendations