Pulmonary Dead Space Monitoring: Identifying Subjects With ARDS at Risk of Developing Right Ventricular Dysfunction.
BACKGROUND: ARDS is a highly morbid condition characterized by diffuse pulmonary inflammation, which results in hypoxemic respiratory failure. Approximately 25% of patients with ARDS develop right ventricular dysfunction, with cor pulmonale being a common final pathway in a significant number of non...
| Publicado en: | Respiratory Care Vol. 64; no. 9; pp. 1101 - 1109 |
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| Autores principales: | , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Sep2019
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138349780&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 138349780 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Sep2019 vid: 64 iid: 9 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 138349780 138349780 138349780 10.4187/respcare.06544 138349780 ppf: 1101 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Pulmonary Dead Space Monitoring: Identifying Subjects With ARDS at Risk of Developing Right Ventricular Dysfunction. aug: au: Papolos, Alexander I. Schiller, Nelson B. Belzer, Annika Hanjing Zhuo Gotts, Jeffery E. Bibby, Dwight Calfee, Carolyn S. Matthay, Michael A. affil: University of California San Francisco Medical Center at Parnassus, Department of Medicine sug: subj: Respiratory Distress Syndrome, Acute Complications Ventricular Dysfunction, Right Risk Factors Respiratory Dead Space Physiology Monitoring, Physiologic Methods Risk Assessment Methods Lung Physiopathology Hemodynamics Human Prospective Studies Nonexperimental Studies Male Female Adult Middle Age Aged Funding Source Echocardiography Methods Tricuspid Valve Physiology Heart Ventricle, Right Physiology Blood Flow Velocity Evaluation Descriptive Statistics Coefficient alpha Confidence Intervals Academic Medical Centers California Echocardiography, Doppler Methods Data Analysis Software Post Hoc Analysis Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: BACKGROUND: ARDS is a highly morbid condition characterized by diffuse pulmonary inflammation, which results in hypoxemic respiratory failure. Approximately 25% of patients with ARDS develop right ventricular dysfunction, with cor pulmonale being a common final pathway in a significant number of non-survivors. ARDS-related right ventricular dysfunction occurs due to acute elevation in ventricular afterload caused by mechanisms that are associated with increased pulmonary dead space fraction. Thus, we hypothesized that changes in pulmonary dead space fraction may reflect changes in pulmonary hemodynamics. METHODS: This was a prospective single-center study of 21 subjects with ARDS who underwent serial determination of pulmonary dead space fraction and pulmonary hemodynamics via transthoracic echocardiography. Linear mixed-effects modeling was performed to test for an association between a change in pulmonary dead space and a change in pulmonary hemodynamics. RESULTS: The tricuspid regurgitation velocity to right ventricular outflow track velocity time integral ratio, an echocardiographic surrogate for pulmonary vascular resistance, increased by 0.16 Wood units (Coefficient 0.16, 95% CI 0.09 - 0.23; P < .001), and the tricuspid regurgitation pressure gradient increased by 3.7 mm Hg (Coefficient 3.7, 95% CI 1.74 -5.63, P < .001) for every 10% increase in pulmonary dead space fraction. CONCLUSIONS: Increases in the pulmonary dead space fraction were associated with relative increases in both the tricuspid regurgitation velocity to right ventricular outflow track velocity time integral ratio and the tricuspid regurgitation pressure gradient, which likely contributed to the high incidence of ARDS-related right ventricular dysfunction encountered in clinical practice. Pulmonary dead space monitoring may serve as a clinical indicator to identify patients with ARDS at risk of developing right ventricular dysfunction and acute cor pulmonale. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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