Articles: respiratory-distress-syndrome.
-
Critical care medicine · Nov 1991
Perfusion of the interventricular septum during ventilation with positive end-expiratory pressure.
To determine whether regional hypoperfusion of the interventricular septum occurs during ventilation with positive end-expiratory pressure. ⋯ The decrease in cardiac output during positive end-expiratory pressure is not caused by impaired interventricular septum blood supply. The preferential perfusion of the right ventricular interventricular septum indicates increased local right ventricular interventricular septum oxygen-demand and suggests that during positive end-expiratory pressure, this part of the interventricular septum functionally dissociates from the left ventricular interventricular septum and the left ventricular free wall to support the stressed right ventricle.
-
Swiss medical weekly · Oct 1991
Review[Non-respiratory therapy of adult respiratory distress syndrome].
Several approaches to non-respiratory management of adult respiratory distress syndrome (ARDS) are discussed. (1) Diagnosis and therapy of the underlying disease is a primary goal in order to avoid the ongoing process of lung injury. (2) Specific pharmacologic therapy for primary lung injury is not available even after 25 years of immunologic research, because no specific mediator has yet been identified as a primary pathogenic factor in ARDS, which is a heterogenous clinical syndrome. (3) Supportive therapy (i.e. improving right ventricular dysfunction and treating pulmonary arterial hypertension) should be emphasized. (4) The most important approach is to optimize prophylactic management to avoid nosocomial infection by eliminating unnecessary invasive techniques, changing the patients' positioning and conserving organ function. So far the latter approach seems to be the only way to improve survival in respiratory failure.
-
Alterations in right ventricular (RV) performance are critical to the cardiac dysfunction witnessed in adult respiratory distress syndrome (ARDS), septic shock (SS), and as a consequence of positive end-expiratory pressure (PEEP) administration during mechanical ventilation. The authors review evidence for right heart dysfunction in these circumstances. In ARDS, an increase in RV afterload with the onset of pulmonary artery hypertension is the predominant factor promoting RV dysfunction. ⋯ The application of PEEP during mechanical ventilation can potentiate alterations in RV preload, afterload, and/or contractility, all of which promote RV dysfunction and compromise left ventricular filling. As RV dysfunction may seriously affect global myocardial performance in all of these settings, the clinician must identify that RV function is impaired, discern the contributing mechanism, and select an appropriate therapeutic regimen targeted at addressing this predominant mechanism. Assessment and management strategies are described.