Document Detail


ICU Management of Patients with Severe Pulmonary Hypertension and Right Heart Failure.
MedLine Citation:
PMID:  21700906     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Despite advances in medical therapies, pulmonary arterial hypertension (PAH), continues to cause significant morbidity and mortality. Although the right ventricle can adapt to an increase in afterload, progression of the pulmonary vasculopathy that characterizes PAH causes many patients to develop progressive right ventricular failure. Furthermore acute right ventricular decompensation may develop from disorders that lead to either an acute increase in cardiac demand such as sepsis, or increase in ventricular afterload including interruptions in medical therapy, arrhythmia, or pulmonary embolism. The poor reserve of the right ventricle, RV ischemia and adverse right ventricular influence on left ventricular filling may lead to a global reduction in oxygen delivery and multi-organ failure. There is a paucity of data to guide clinicians caring for acute right heart failure in PAH. Treatment recommendations are frequently based upon animal models of acute right heart failure or case series in humans with other causes of pulmonary hypertension. Successful treatment often requires that invasive hemodynamics be used to monitor the effect of strategies that are based primarily upon biological plausibility. Herein we have developed an approach based upon the current understanding of RV failure in PAH and have attempted to develop a treatment paradigm based upon physiological principles and available evidence.
Authors:
Marius M Hoeper; John Granton
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-6-23
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  -     ISSN:  1535-4970     ISO Abbreviation:  -     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-6-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
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