Pathophysiology and causes of pulmonary hypertension

2016 ◽  
Author(s):  
Laura Price ◽  
S. John Wort
Keyword(s):  
Pulmonary Hypertension ◽  
Critical Illness ◽  
Positive Pressure Ventilation ◽  
Massive Pulmonary Embolism ◽  
Positive Pressure ◽  
Vasoactive Drugs ◽  
Acute Decompensation ◽  
Prognostic Feature ◽  
Pulmonary Arterial ◽  
Poor Prognostic Feature

Pulmonary hypertension (PH) in the setting of critical illness may reflect the acute syndrome itself (such as acute massive pulmonary embolism or acute lung injury), and/or pre-existing ‘chronic’ causes of PH. To compound this, iatrogenic factors may also contribute to PH including the effects of positive pressure ventilation and certain vasoactive drugs. The presence of PH, especially when complicated by resulting right ventricular (RV) dysfunction and failure, is a poor prognostic feature in all settings. This chapter reviews the pathophysiology of acute PH in critical illness, and pre-existing chronic causes of PH, including acute decompensation in patients with pre-existing pulmonary arterial hypertension.

scholarly journals Primary alveolar hypoventilation and XXXXY chromosopathy

2016 ◽  
Vol 65 (3) ◽  
Author(s):  
D. Samolski ◽  
A. Antón ◽  
M. Mayos ◽  
M. Subirana ◽  
R. Güell
Keyword(s):  
Respiratory Failure ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Positive Pressure Ventilation ◽  
Cor Pulmonale ◽  
Positive Pressure ◽  
Hypercapnic Respiratory Failure ◽  
Non Invasive ◽  
Alveolar Hypoventilation ◽  
Pulmonary Arterial

The association of primary alveolar hypoventilation (PAH) and chromosomic diseases has not been described previously. A 19 year-old man with Fraccaro’s syndrome (XXXXY karyotype) was admitted to evaluate chronic hypercapnic respiratory failure, pulmonary arterial hypertension and cor pulmonale. PAH was diagnosed. As effective treatment, such as non-invasive positive pressure ventilation (NIPPV), is available for this disorder we should intensify the search for PAH in patients with chromosome disease.

Management of Pulmonary Arterial Hypertension in the ICU

2019 ◽  
Vol 32 (3) ◽  
pp. 303-313 ◽  
Author(s):  
Heather Torbic
Keyword(s):  
Critical Illness ◽  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Progressive Disease ◽  
Hemodynamic Instability ◽  
Organ Damage ◽  
Health Care Team ◽  
Acute Decompensation ◽  
Pulmonary Arterial ◽  
Rv Function

Patients with pulmonary arterial hypertension (PAH) who are admitted to the intensive care unit (ICU) pose a challenge to the multidisciplinary health-care team due to the complexity of the pathophysiology of their disease state and the medication considerations that must be made to appropriately manage them. PAH is a progressive disease with the majority of patients ultimately dying as a result of right ventricular (RV) failure. During an acute decompensation, patients must be appropriately managed to optimize volume status, RV function, cardiac output, and systemic perfusion, while treating the underlying cause of the exacerbation. During times of critical illness, the ability to administer medications approved for use in PAH can be impacted by end-organ damage, hemodynamic instability, new drug interactions, or available dosage forms. Balancing the multimodal treatment approach needed to manage an acute exacerbation and the pharmacokinetic and administration concerns impacting baseline PAH therapy as a result of critical illness requires an expert multiprofessional PAH team. The purpose of this review is to evaluate specific management considerations for critically ill patients with PAH in the ICU.

Successful treatment of secondary pulmonary hypertension by long-term non-invasive positive pressure ventilation

2006 ◽  
Vol 2 (4) ◽  
pp. 120-122
Author(s):  
Toru Kadowaki ◽  
Hironobu Hamada ◽  
Naohiko Hamaguchi ◽  
Ryoji Ito ◽  
Hitoshi Katayama ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Successful Treatment ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Non Invasive ◽  
Secondary Pulmonary Hypertension

scholarly journals Veno-venous extracorporeal membrane oxygenation in the management of refractory bilateral bronchial dehiscence after lung transplant: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Makiko Tani
Keyword(s):  
Lung Transplant ◽  
Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Case Presentation ◽  
Life Threatening ◽  
Pulmonary Arterial ◽  
Bilateral Lung ◽  
Bridge Therapy ◽  
Extracorporeal Oxygenation ◽  
Vv Ecmo

Abstract Background Bronchial dehiscence is a life-threatening complication after lung transplant. If it is not treated by placement of stent or reanastomosis, the chance of survival will depend on the availability of a new graft. However, retransplant is not a practical management option in Japan, where waiting time for lung transplant is extensive. We described a case of refractory bilateral bronchial dehiscence managed by veno-venous extracorporeal oxygenation membrane (VV ECMO) while allowing the dehiscence to heal. Case presentation A 25-year-old man with idiopathic pulmonary arterial hypertension underwent a bilateral lung transplant. The patient developed bilateral bronchial dehiscence. Open reanastomosis was not successful, and air leakage recurred under low positive pressure ventilation. VV ECMO was established to maintain oxygenation with spontaneous breathing until both dehiscence were closed by adhesions. Conclusion In a patient with refractory bilateral bronchial dehiscence, VV ECMO may provide bronchial rest and serve as a bridge therapy to recovery.

Diagnosis and management of pulmonary hypertension

2016 ◽  
Author(s):  
Philip Marino ◽  
Laura Price
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Critical Illness ◽  
Management Strategies ◽  
Haemodynamic Monitoring ◽  
Vasoactive Agents ◽  
Non Invasive ◽  
Pulmonary Vasodilators ◽  
Surgical Options ◽  
Pulmonary Arterial

The diagnosis of pulmonary hypertension (PH) and associated right ventricular (RV) dysfunction or failure in the setting of critical illness relies on the use of non-invasive tools including echocardiography, and in some cases invasive haemodynamic monitoring. The management for PH and RV failure in the ICU may be challenging, and is dependent on local expertise and drug availability.Systemic vasoactive agents and pulmonary vasodilators play an important role. Patients with pulmonary arterial hypertension, pulmonary embolism or chronic thromboembolic PH should be anticoagulated; those with haemodynamically unstable PE may require thrombolysis.The characteristics of individual agents must be considered and monitored carefully.Few clinical studies or ICU-specific guidelines exist. Surgical options exist for patients with PH and RV failure. This chapter reviews the diagnostic and management strategies of PH and RV failure in the ICU setting.

Intermittent positive pressure ventilation increases diastolic pulmonary arterial pressure in advanced COPD

Heart & Lung ◽  
2015 ◽  
Vol 44 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Jeremy P. Wrobel ◽  
Bruce R. Thompson ◽  
Christopher R. Stuart-Andrews ◽  
Kirk Kee ◽  
Gregory I. Snell ◽  
...  
Keyword(s):  
Arterial Pressure ◽  
Positive Pressure Ventilation ◽  
Pulmonary Arterial Pressure ◽  
Intermittent Positive Pressure Ventilation ◽  
Positive Pressure ◽  
Pulmonary Arterial
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