scholarly journals PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

2021 ◽  
Vol 8 ◽  
Author(s):  
Longxiang Su ◽  
Pan Pan ◽  
Huaiwu He ◽  
Dawei Liu ◽  
Yun Long
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Heart Function ◽  
Transpulmonary Pressure ◽  
Right Heart ◽  
Right Heart Function ◽  
Starting Point ◽  
Respiratory Treatment ◽  
The Right ◽  
Right Ventricular Preload

Pulse pressure variation (PPV) is a mandatory index for hemodynamic monitoring during mechanical ventilation. The changes in pleural pressure (Ppl) and transpulmonary pressure (PL) caused by mechanical ventilation are the basis for PPV and lead to the effect of blood flow. If the state of hypovolemia exists, the effect of the increased Ppl during mechanical ventilation on the right ventricular preload will mainly affect the cardiac output, resulting in a positive PPV. However, PL is more influenced by the change in alveolar pressure, which produces an increase in right heart overload, resulting in high PPV. In particular, if spontaneous breathing is strong, the transvascular pressure will be extremely high, which may lead to the promotion of alveolar flooding and increased RV flow. Asynchronous breathing and mediastinal swing may damage the pulmonary circulation and right heart function. Therefore, according to the principle of PPV, a high PPV can be incorporated into the whole respiratory treatment process to monitor the mechanical ventilation cycle damage/protection regardless of the controlled ventilation or spontaneous breathing. Through the monitoring of PPV, the circulation-protective ventilation can be guided at bedside in real time by PPV.

Right ventricular function

2020 ◽  
pp. 119-132
Author(s):  
Michelle S. Chew
Keyword(s):  
Ventricular Function ◽  
Heart Function ◽  
Left Ventricular ◽  
Function Estimation ◽  
Right Heart ◽  
Right Heart Function ◽  
Disease States ◽  
Echocardiographic Examination ◽  
Systolic And Diastolic Function ◽  
The Right

The right ventricle (RV) has historically been given less importance than the left. There are important anatomical differences, including several intracardiac structures that may complicate echocardiographic assessments. The right heart is sensitive to changes in pressure and its function is affected by common interventions in critical care such as fluid loading and positive pressure ventilation. Right and left ventricular functions are inextricably linked, and both systolic and diastolic ventricular interdependence occur. The echocardiographic examination of the RV includes an assessment of size and dimensions, systolic and diastolic function, estimation of intracardiac and pulmonary pressures. These should be interpreted in the context of the clinical interventions that the patient was subjected to at the time of imaging, as well as left ventricular function. RV failure is associated with poorer outcomes in several disease states including congestive cardiac failure and acute myocardial infarction. In critically ill patients, acute respiratory distress syndrome (ARDS) has significant implications for right heart function, where there is a necessary balance between respiratory mechanics and haemodynamics.

The Effect of Aminophylline on Right Heart Function in Young Pigs after Ligation of the Right Coronary Artery

2008 ◽  
Vol 86 (4) ◽  
pp. 192-196
Author(s):  
Michael B. Spalding ◽  
Tero I. Ala-Kokko ◽  
Kai Kiviluoma ◽  
Heikki Ruskoaho ◽  
Seppo Alahuhta
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Heart Function ◽  
Right Heart ◽  
Right Heart Function ◽  
Young Pigs ◽  
The Right

scholarly journals The effect of levosimendan on right ventricular function in patients with heart dysfunction: a systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yaoshi Hu ◽  
Zhe Wei ◽  
Chaoyong Zhang ◽  
Chuanghong Lu ◽  
Zhiyu Zeng
Keyword(s):  
Systematic Review ◽  
Pulmonary Arterial Pressure ◽  
Heart Function ◽  
Systolic Function ◽  
Meta Analysis ◽  
Right Heart ◽  
Heart Dysfunction ◽  
Right Heart Function ◽  
Pulmonary Arterial ◽  
The Right

AbstractLevosimendan exerts positive inotropic and vasodilatory effects. Currently, its effects on right heart function remain uncertain. This systematic review and meta-analysis is intended to illustrate the impacts of levosimendan on systolic function of the right heart in patients with heart dysfunction. We systematically searched electronic databases (PubMed, the Cochrane Library, Embase and Web of Science) up to November 30, 2020, and filtered eligible studies that reported the impacts of levosimendan on right heart function. Of these, only studies whose patients suffered from heart dysfunction or pulmonary hypertension were included. Additionally, patients were divided into two groups (given levosimendan or not) in the initial research. Then, RevMan5.3 was used to conduct further analysis. A total of 8 studies comprising 390 patients were included. The results showed that after 24 h of levosimendan, patients’ right ventricular fractional area change [3.17, 95% CI (2.03, 4.32), P < 0.00001], tricuspid annular plane systolic excursion [1.26, 95% CI (0.35, 2.16), P = 0.007] and tricuspid annular peak systolic velocity [0.86, 95% CI (0.41, 1.32), P = 0.0002] were significantly increased compared to the control group. And there is an increasing trend of cardiac output in levosimendan group [1.06, 95% CI (− 0.16, 2.29), P = 0.09 ] .Furthermore, patients’ systolic pulmonary arterial pressure [− 5.57, 95% CI (− 7.60, − 3.54), P < 0.00001] and mean pulmonary arterial pressure [− 1.01, 95% CI (− 1.64, − 0.37), P = 0.002] were both significantly decreased, whereas changes in pulmonary vascular resistance [− 55.88, 95% CI (− 206.57, 94.82), P = 0.47] were not significant. Our study shows that in patients with heart dysfunction, levosimendan improves systolic function of the right heart and decreases the pressure of the pulmonary artery.

The right ventricle in critical illness

2017 ◽  
Author(s):  
Claire Colebourn ◽  
Jim Newton
Keyword(s):  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Heart Function ◽  
Structure And Function ◽  
Care Practice ◽  
Right Heart ◽  
Right Heart Function ◽  
Ventricular Structure ◽  
The Right ◽  
And Function

This chapter describes the unique aspects of right ventricular structure and function and relates this to the effects of an acute or chronic rise in pulmonary vascular resistance on the right heart. Assessment of pulmonary vascular resistance and right heart function is described in detail. The usage of this assessment in critical care practice is then explored, with particular reference to mechanical ventilation and pulmonary embolism.

Effects of the MitraClip on right heart function and tricuspid valve regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ahmed
Keyword(s):  
Mitral Regurgitation ◽  
Tricuspid Regurgitation ◽  
Heart Function ◽  
Funding Source ◽  
Right Heart ◽  
Vena Contracta ◽  
Right Heart Function ◽  
Flow Convergence ◽  
The Right ◽  
Rv Function

Abstract   The MitraClip has been established as a therapeutic option for patients with symptomatic mitral regurgitation (MR) and increased risk of Surgery. MR is often combined with a decrease in right heart function due to the volume and pressure overload it leads to. The effects of MR reduction by MitraClip on right heart function is currently not adequately determined. The study further addresses the question of whether and when it makes sense to correct combined tricuspid regurgitation (TR). Methods All Patients that took part in this study underwent 2D and 3D Echocardiography before MitraClip implantation as well as six months afterwards. RV Function was evaluated through 4 Parameters: Tricuspid annular plane systolic excursion (TAPSE) in mm, tricuspid annular systolic velocity (TASV) in cm/s, right ventricular fractional area change (RVFAC) in % and myocardial performance index (MPI). Estimated right ventricular systolic pressure (RVSP) in mmHg was used as evidence for the presence of pulmonic Hypertension. Further Parameters determined the severity of TR and the dimensions of the right ventricle (RV) and atrium (RA) in cm respectively the volume in ml. Results 60 Patients were recruited (63% male, Age 81.4±7.1). Six Months (±3) after MitraClip implantation a significant improvement in right heart parameters was noticed. Most of the parameters used in this study showed a significant change. (TASV 9.3±2.4 vs. 10.5±2.6, p=0.01), (RVFAC 33.1±10.9 vs. 39.0±9.6, p&lt;0.05). TAPSE showed an improvement by trend (16.1±4.6 vs. 17.4±4.8, p=0.06). RVSP showed a significant decrease (51.9±12.3 vs. 44.6±13.4, P&lt;0.05). However, Dimensions and Volume of the right atrium and ventricle showed no significant change. On the other hand, the average TR severity has noticeably declined after 6 months (2.1±0.7 vs. 1.6±0.6, p&lt;0.05). Flow Convergence and Vena contracta of Tricuspid regurgitation also demonstrated a significant reduction (Flow Convergence 7.6±4.5 vs. 5.9±2.5, P=0.01), (Vena contracta 6.8±2.5 vs. 5.4±1.9, p&lt;0.05). Conclusion MitralClip leads to a reduction in Mitral regurgitation which leads to a significant improvement in the right heart parameters, especially the RV Function. A noticeable decrease in the TR severity was often seen as an accompanying effect. An initially wait-and-see approach to a residual TR appears justified. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Heart Center University Clinic Dresden, Germany

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