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2. Diagnostic workup, etiologies and management of acute right ventricle failure

Author

Vieillard-Baron, Antoine, Naeije, R., Haddad, F., Bogaard, H. J., Bull, T. M., Fletcher, N., and Lahm, T.

Subjects
Medical colleges, Company business management, Health care industry
Abstract

Introduction This is a state-of-the-art article of the diagnostic process, etiologies and management of acute right ventricular (RV) failure in critically ill patients. It is based on a large review of previously published articles in the field, as well as the expertise of the authors. Results The authors propose the ten key points and directions for future research in the field. RV failure (RVF) is frequent in the ICU, magnified by the frequent need for positive pressure ventilation. While no universal definition of RVF is accepted, we propose that RVF may be defined as a state in which the right ventricle is unable to meet the demands for blood flow without excessive use of the Frank-Starling mechanism (i.e. increase in stroke volume associated with increased preload). Both echocardiography and hemodynamic monitoring play a central role in the evaluation of RVF in the ICU. Management of RVF includes treatment of the causes, respiratory optimization and hemodynamic support. The administration of fluids is potentially deleterious and unlikely to lead to improvement in cardiac output in the majority of cases. Vasopressors are needed in the setting of shock to restore the systemic pressure and avoid RV ischemia; inotropic drug or inodilator therapies may also be needed. In the most severe cases, recent mechanical circulatory support devices are proposed to unload the RV and improve organ perfusion Conclusion RV function evaluation is key in the critically-ill patients for hemodynamic management, as fluid optimization, vasopressor strategy and respiratory support. RV failure may be diagnosed by the association of different devices and parameters, while echocardiography is crucial., Author(s): Antoine Vieillard-Baron [sup.1] [sup.2], R. Naeije [sup.3], F. Haddad [sup.4], H. J. Bogaard [sup.5], T. M. Bull [sup.6], N. Fletcher [sup.7], T. Lahm [sup.8], S. Magder [sup.9], S. Orde [...]

Published
2018
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22. Posters

Author

Török, T., Kardos, A., Rudas, L., Paprika, D., McLuckie, A., Beale, R. J., Bihari, D., Keller, H., Seltzer, N., Weimer, A., Menning, H., Ulrich, P., Staedt, U., Kirschstein, W., Kasai, T., Endo, S., Arakawa, N., Sato, N., Suzuki, T., Taniguchi, S., Inada, K., Hiramori, K., Schmidt, W., Meineke, I., Nottrott, M., Frerichs, I., Müller, S., Hellige, G., De Blasio E., De Sio A., Sibilio G., Papa A., Golia D., Grassia V., Bove G., Zehelgruber, M., Mundigler, G., Christ, G., Merhaut, C., Klaar, U., Kratochwill, C., Hofmann, S., Siostrzonek, P., Suarez, F., Corrales, M., Rábago, R., Gonzalez-Arenas, P., Morales, R., Sanchez J., Fraile, J., Rey, M., Martinell, J., Niederst, P. -N., Mellwig, K. -P., Schmidt, H. K., Gleichmann, U., Körfer, R., Di Bartolomeo, S., Bertolissi, M., Nardi, G., De Monte, A., Janssens, U., Ochs, J. -G., Klues, H. G., Hanrath, P., Sajjanhar, T., Tibby, S. M., Hatherill, M., Anderson, D., Murdoch, I. A., Krivec, B., Voga, G., Žuran, I., Skale, R., Parežnik, R., Podbregar, M., Bonnefoy, E., Chevalier, P., Kirkorian, G., Guidolet, J., Marchand, A., Bouchayer, D., Marcaz, P. Bert, Touboul, P., Welte, T., Molling, J., Jepsen, M. S., Claus, G., Klein, H., Cinnella, G., Dambrosio, M., Brienza, N., Conte, M., Maggiore, S. M., Leone, A. M., Brienza, A., DiVenere, N., Vandewoude, K., Poelaert, J., Vogelaers, D., Garcia, R. Blanca, Buylaert, W., Roosens, C., Colardyn, F., Annane, D., Béllissant, E., Pussard, E., Asmar, R., Lacombe, F., Lanata, E., Madonna, O., Safar, M., Giudicelli, J. F., Raphael, J. C., Gajdos, Ph., Mattys, M., Dumont, L., Annaert, J. F., Mardirosoff, C., Goldstein, J., Verbeet, T., Massaut, J., Haas, N. A., Uhlemann, F., Daehnert, I., Berger, F., Stiller, B., Dittrich, S., Schulze-Neick, I., Eweit, P., Lange, P. E., Langenherp, C. J. M., Pietersen, H., Geskes, G., Wagenmakers, A., Soeters, P., Maggiorini, M., Brimioulle, S., Lejeune, P., Delcroix, M., Vermeulen, F., Stephanazzi, J., Naeije, R., Kunert, M., Stolzenburg, H., Scheuble, L., Emmerich, K., Ulbricht, L. J., Krakau, I., Gülker, H., Broch, M. J., Valentín, V., Murcia, B., Bartual, E., Málaga, A., Miralles, L. L., Valls, F., Wallin, C. J., Sidenö, B., Vaage, J., Leksell, L. G., Stuchlinger, H. G., Seidler, D., Hollenstein, U., Janata, K., Muellner, M., Loeffler, W., Gamper, G., Bur, A., Malzer, R., Laggner, A. N., Hirschl, M. M., Binder, M., Herkner, H., Bur, A., Laggner, A. N., Turani, F., Ceraso, C., Lironcurti, A., Senesi, P., Leonardis, C., Sabato, A. F., Pietersen H. G., Langenberg C. J. M., Geskes G., Wagenmakers A. J. M., de Lange S., Soeters P. B., Royira, A., Oussedik, L., Cambray, C., Glmeno, C., Cerda, M., Sanchez, Ma. A., Lesmes, A., Guerrero, M., Vigil, E., Ortega, F., Lucena, F., Righini, E. R., Alvisi, R., Marangoni, E., Gritti, G., Ordóñez, A., Hernández, A., Pérez-Bernal, J., Hinojosa, R., Borrego, J. M., Franco, A., López-Barneo, J., Pérez-Bernal, J., Gutiérrez, E., Hinojosa, R., Hernández, A., Borrego, J. M., Cerro, J., Rincón, D., Ordóñez, A., Martin, R., Saussine, M., Sany, C. L., Calvet, B., Raison, D., Frapier, J. M., Wallin, C. -J., Olsson, Å., Nordländer, R., Leksell, L. G., Vasilkov, V., Safronov, A., Marinchev, V., Rodrigues, A. C., Moraes, A., Galas, F., Angelim, V., Medeiros, C., Auler, J. O., Bellotti, G., Pilleggi, F., Carmona, M. J., Messias, E. R. R., Joseph, D., Baigorri, F., Artigas, A., Blanch, L., Wagner, F., Dandel, M., Günther, G., Schulze-Neick, I., Weng, Y., Loebe, M., Hetzer, R., Colreavy, F., Balea, M., Cahalan, M., Carpintero, JL., de la Fuente, M. C., Estecha, M. A., Molina, J. M., del Fresno, L. R., Daga, D., Toro, R., Poullet, A., de la Torre, M. V., Garcia, A. J., Michalopoulos, A., Rellos, K., Skambas, D., Liakopoulos, O., and Geroulanos, S.

Published
1996
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26. Acute/Chronic respiratory failure III

Author

Mondèjar, E. Fernàndez, Mata, G. Vazquez, Ferròn, F., Navarrete, P., Ruiz, J. M. Torres, Lestavel, P., Tronchon, L., Chambrin, M. C., Mangalaboyi, J., Rime, A., Chopin, C., Valta, P., Campodonico, R., Corbeil, C., Chassè, M., Châtillon, A., Braidy, J., Matar, N., Milic-Emili, J., Lòpez-Messa, J., Penas, L., Valverde, A., Dambrosio, M., Roupie, E., Carneiro, A., Anglade, M. C., Vasile, N., Brochard, L., Lemaire, F., Rubio, J., Carrasco, M. S., Mateo, I., Sierra, R., Escolar, A., Cozar, J., Bastin, K., Knapen, R., Moraine, J. J., Melot, C., Sergysels, R., Kahn, R. J., Pelosi, P., Cereda, M., Foti, G., D’Andrea, L., Manetti, B., Lissoni, A., Pesenti, A., Gallego, J. M. Allegue, Rubi, J. A. Gòmez, Sànchez, C. Palazòn, Moreno, A. Melgarejo, Lherm, T., Boiteau, R., Valente, E., Beaussier, M., Chamieh, F., Tenaillon, A., Righini, E. R., Alvisi, R., Ragazzi, R., Volta, C. A., Capuzzo, M., Gritti, G., Sydow, M., Burchardi, H., Zinserling, J., Crozier, T. A., Guttmann, J., Eberhard, L., Bertschmann, W., Fabry, B., Wolff, G., Rubini, A., DelMonte, D. D., Catena, V., Attar, I., Rattazzi, G., Alati, G. L., Diaz, M. Arias, Mata, G. Vàzquez, Navarro, P. Navarrete, Lòpez, F. Guerrero, Morales, A. Mèrida, Isenegger, J., Picazo, L., Sanchez, A., Hernandez, B., Pons, A., Conti, G., Di Chiara, L., De Blasi, R. A., Dell’Utri, D., Cogliati, A., Pelaia, P., Ferretti, A., Bernasconi, F., Banfi, G., Pesenti, A., Putensen, C., Putensen-Himmer, G., Leon, M., Huygen, P. E. M., Gültuna, I., Zwart, A., Ince, C., Bruining, H. A., Pompe, J. C., Kesecioĝlu, J., Rabbat, A., Laaban, J. P., Orvoen-Frija, E., Achkar, A., Rochemaure, J., Frigo, V., Solca, M., Melloni, G., Gerbsa, C., Ornaghi, A., Mancini, S., Cavagnoli, R., Fasano, W., Santos, C., Roca, J., Torres, A., Cardùs, J., Barberà, J. A., Felez, M. A., Rodriguez-Roisin, R., Oviedo-Moreira, R., Beydon, L., Nakos, G., Precates, A., Mathas, C., Bassilakis, N., Chagianagnostou, K., Massoura, L., Labropoulos, S., Devroey, M., Vansnick, P., Mèlot, C., Naeije, R., Nagy, V., Kiiski, R., Kaitainen, S., Karppi, R., Takala, J., Kesecioglu, J., Erdmann, W., Marin, J., Arnau, A., Tejeda, M., Olivares, D., Servera, E., Boix, J. H., Alvarez, F., Peydro, F., Mira, J. P., Belghith, M., Renaud, B., Deland, E., Brunet, F., Brusset, A., Lanore, J. J., Hamy, I., Termignon, J. L., Soubrane, O., Pochard, F., Dhainaut, J. F., Sidhu, P. S., Cockburn, J. F., Nicholson, D. A., Kennedy, A., Dawson, P., and Servera, F. E.

Published
1992
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28. Imaging of Improved Right Ventricular Coupling, Risk Status and Survival in Pulmonary Arterial Hypertension

Author

Badagliacca, R., Papa, S., D'Alto, M., Ghio, S., Argiento, P., Brunetti, N., Casamassima, V., Casu, G., Cedrone, N., Confalonieri, M., Corda, M., Correale, M., D'Agostino, C., De Michele, L., Galgano, G., Greco, A., Lombardi, C., Manzi, G., Mercurio, V., Mulè, M., Paciocco, G., Romaniello, A., Romeo, E., Scelsi, L., Stolfo, D., Vitulo, P., Naeije, R., and Vizza, C.

Published
2022
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37. Free Papers

Author

Scheeren, T. W. L., Arndt, J. O., Sehulze-Neick, I., Nürnberg, J. H., Uhlemann, F., Haas, N. A., Berger, F., Opitz, C., Kleber, F. X., Rossaint, R., Hetzer, R., Lange, P. E., Annane, D., Blanc, A. S., Raphael, J. C., Gajdos, Ph., Maggiorini, M., Brimioulle, S., Lejeune, P., Delcroix, M., Vermeulen, F., Stephanazzi, J., Naeije, R., Petros, S., Schädlich, H., Lehmann, I., and Engelmann, L.

Published
1996
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38. Nitric oxide in ARDS

Author

Rossaint, R., Falke, K. J., Keitel, M., Lopez, F., Pison, U., Slama, K., Grünina, T., Lewandowski, K., Zapol, W. M., Steudel, W., Payen D., Gatecel C., Guinard N., de Beyl, V. Zegers, Leeman, M., Gilbert, E., Mélot, C., Naeije, R., Rovira, I., Chen, T. Y., Greene, E., Law-koune J. D., Moutafis M., and Fischler M.

Published
1992
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39. Decreased pulmonary vascular distensibility in adolescents conceived by in vitro fertilization.

Author

Forton, K, Motoji, Y, Pezzuto, B, Caravita, S, Delbaere, A, Naeije, R, and Faoro, V

Subjects
FERTILIZATION in vitro, TEENAGERS, AEROBIC capacity, EXERCISE tests, CARBON monoxide analysis, AEROBIC exercises, VASCULAR resistance
Abstract

Study Question: What is the functional relevance of decreased pulmonary vascular distensibility in adolescents conceived by IVF?Summary Answer: Children born by IVF have a slight decrease in pulmonary vascular distensibility observed during normoxic exercise that is not associated with altered right ventricular function and aerobic exercise capacity.What Is Known Already: General vascular dysfunction and increased hypoxic pulmonary hypertension have been reported in ART children as compared to controls. Pulmonary hypertension or decreased pulmonary vascular distensibility may affect right ventricular function and thereby possibly limit maximal cardiac output and aerobic exercise capacity.Study Design, Size, Duration: This prospective case-control study enrolled 15 apparently healthy adolescents conceived by IVF/ICSI after fresh embryo transfer paired in a 2 to 1 ratio to 30 naturally conceived adolescents between March 2015 and May 2018.Participants/materials, Setting, Methods: Fifteen IVF/ICSI adolescents and 30 controls from singleton gestations matched by age, gender, weight, height and physical activity underwent exercise echocardiography, lung diffusion capacity measurements and a cycloergometer cardiopulmonary exercise test. A pulmonary vascular distensibility coefficient α was determined from the pulmonary arterial pressure (PAP) versus cardiac output (Q) relationships. Pulmonary capillary volume (Vc) was calculated from single breath nitric oxide and carbon monoxide lung diffusion capacity measurements (DLCO and DLNO) at rest and during exercise (100 W). Eight of the IVF subjects and eight controls underwent a 30 min hypoxic challenge at rest with a fraction of inspired oxygen of 0.12 to assess hypoxic pulmonary vasoconstriction.Main Results and the Role Of Chance: In normoxia, oxygen uptake (VO2), blood pressure, DLCO, DLNO, echocardiographic indices of right ventricular function, Q and PAP at rest and during exercise were similar in both groups. However, IVF children had a lower pulmonary vascular distensibility coefficient α (1.2 ± 0.3 versus 1.5 ± 0.3%/mmHg, P = 0.02) and a blunted exercise-induced increase in Vc (24 versus 32%, P < 0.05). Hypoxic-induced increase in pulmonary vascular resistance in eight IVF subjects versus eight controls was similar.Limitations, Reasons For Caution: The IVF cohort was small, and thus type I or II errors could have occurred in spite of careful matching of each case with two controls. ART evolved over the years, so that it is not certain that the presently reported subtle changes will be reproducible in the future. As the study was limited to singletons born after fresh embryo transfers, our observations cannot be extrapolated to singletons born after frozen embryo transfer.Wider Implications Of the Findings: The present study suggests that adolescents conceived by IVF have preserved right ventricular function and aerobic exercise capacity despite a slight alteration in pulmonary vascular distensibility as assessed by two entirely different methods, i.e. exercise echocardiography and lung diffusing capacity measurements. However, the long-term prognostic relevance of this slight decrease in pulmonary vascular distensibility needs to be evaluated in prospective large scale and long-term outcome studies.Study Funding/competing Interest(s): Dr Caravita was supported by an ERS PAH short term research training fellowship (STRTF2014-5264). Dr Pezzuto was funded by an Italian Society of cardiology grant. Dr Motoji was supported by a grant from the Cardiac Surgery Funds, Belgium. All authors have no conflicts of interests to declare. [ABSTRACT FROM AUTHOR]

Published
2019
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49. Exercise stress echocardiography of the pulmonary circulation: limits of normal and sex differences.

Author

Argiento P, Vanderpool RR, Mulè M, Russo MG, D'Alto M, Bossone E, Chesler NC, Naeije R, Argiento, Paola, Vanderpool, Rebecca R, Mulè, Massimiliano, Russo, Maria Giovanna, D'Alto, Michele, Bossone, Eduardo, Chesler, Naomi C, and Naeije, Robert

Abstract

Background: Exercise stress echocardiography has not been recommended in the diagnostic workup of pulmonary hypertension because of insufficient certainty about feasibility and limits of normal.Methods: Doppler echocardiography pulmonary hemodynamic measurements were performed at a progressively increased workload in 56 healthy male and 57 healthy female volunteers aged 19 to 63 years. Mean pulmonary artery pressure (mPAP) was estimated from the maximal tricuspid regurgitation jet velocity. Cardiac index was calculated from the left ventricular outflow velocity-time integral. Pulmonary vascular distensibility a index, the percentage change of vessel diameter permm Hg of mPAP, was calculated from multipoint mPAP-cardiac output (CO) plots.Results: Peak exercise at 175 ±50 W was associated with an mPAP of 33±7 mm Hg and a CO of 18 ±5 L/min. The slope of mPAP-CO relationships was 1.5 ± 0.5 mm Hg/L/min, and the distensibility coefficient ( α ) was 1.3%± 1.0%/mm Hg. Maximal workload and cardiac index were higher in men than in women ( P , .05), but mPAP-cardiac index relationships were not different. However,women had a higher a (1.6%± 1.3%/mm Hg vs 1.1%± 0.6%/mm Hg, P < .05). The average mPAP-cardiac index slope was higher and a lower in subjects ≥50 years old. Upper limits of normal of mPAP at exercise were 34 mm Hg at a CO , 10 L/min, 45 mm Hg at a CO <20 L/min, and 52 mm Hg at a CO<30 L/min. These values are in keeping with previously reported invasive measurements.Conclusions: Exercise stress echocardiography of the pulmonary circulation is feasible and allows for fl ow-corrected definition of upper limits of normal. Women have a more distensible pulmonary circulation. [ABSTRACT FROM AUTHOR]

Published
2012
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50. Exercise pathophysiology in patients with chronic mountain sickness exercise in chronic mountain sickness.

Author

Groepenhoff H, Overbeek MJ, Mulè M, van der Plas M, Argiento P, Villafuerte FC, Beloka S, Faoro V, Macarlupu JL, Guenard H, de Bisschop C, Martinot JB, Vanderpool R, Penaloza D, Naeije R, Groepenhoff, Herman, Overbeek, Marieke J, Mulè, Massimiliano, van der Plas, Mart, and Argiento, Paola

Abstract

Background: Chronic mountain sickness (CMS) is characterized by a combination of excessive erythrocytosis,severe hypoxemia, and pulmonary hypertension, all of which affect exercise capacity.Methods: Thirteen patients with CMS and 15 healthy highlander and 15 newcomer lowlander control subjects were investigated at an altitude of 4,350 m (Cerro de Pasco, Peru). All of them underwent measurements of diffusing capacity of lung for nitric oxide and carbon monoxide at rest, echocardiography for estimation of mean pulmonary arterial pressure and cardiac output at rest and at exercise, and an incremental cycle ergometer cardiopulmonary exercise test.Results: The patients with CMS, the healthy highlanders, and the newcomer lowlanders reached a similar maximal oxygen uptake at 32 1, 32 2, and 33 2 mL/min/kg, respectively, mean SE( P 5 .8), with ventilatory equivalents for C O 2 vs end-tidal P CO 2 , measured at the anaerobic threshold,of 0.9 0.1, 1.2 0.1, and 1.4 0.1 mm Hg, respectively ( P , .001); arterial oxygen content of 26 1, 21 2, and 16 1 mL/dL, respectively ( P , .001); diffusing capacity for carbon monoxide corrected for alveolar volume of 155% 4%, 150% 5%, and 120% 3% predicted, respectively( P , .001), with diffusing capacity for nitric oxide and carbon monoxide ratios of 4.7 0.1 at sea level decreased to 3.6 0.1, 3.7 0.1, and 3.9 0.1, respectively ( P , .05) and a maximal exercise mean pulmonary arterial pressure at 56 4, 42 3, and 31 2 mm Hg, respectively ( P , .001).Conclusions: The aerobic exercise capacity of patients with CMS is preserved in spite of severe pulmonary hypertension and relative hypoventilation, probably by a combination of increased oxygen carrying capacity of the blood and lung diffusion, the latter being predominantly due to an increased capillary blood volume. [ABSTRACT FROM AUTHOR]

Published
2012
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