In this section
@article{Price:2010:10.1186/cc9264,
author = {Price, LC and Wort, SJ and Finney, SJ and Marino, PS and Brett, SJ},
doi = {10.1186/cc9264},
journal = {Critical Care},
title = {Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review},
url = {http://dx.doi.org/10.1186/cc9264},
volume = {14},
year = {2010}
}
TY - JOUR
AB - Introduction: Pulmonary vascular dysfunction, pulmonary hypertension (PH), and resulting right ventricular (RV)failure occur in many critical illnesses and may be associated with a worse prognosis. PH and RV failure may bedifficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, andreduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed updateon the management of PH and RV failure in adult critical care.Methods: A systematic review was performed, based on a search of the literature from 1980 to 2010, by usingprespecified search terms. Relevant studies were subjected to analysis based on the GRADE method.Results: Clinical studies of intensive care management of pulmonary vascular dysfunction were identified,describing volume therapy, vasopressors, sympathetic inotropes, inodilators, levosimendan, pulmonary vasodilators,and mechanical devices. The following GRADE recommendations (evidence level) are made in patients withpulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that closemonitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (lowqualityevidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) lowdosevasopressin may be useful to manage patients with resistant vasodilatory shock. 4) A weak recommendation(low-moderate quality evidence) is made that low-dose dobutamine improves RV function in pulmonary vasculardysfunction. 5) A strong recommendation (moderate-quality evidence) is made that phosphodiesterase type IIIinhibitors reduce PVR and improve RV function, although hypotension is frequent. 6) A weak recommendation(low-quality evidence) is made that levosimendan may be useful for short-term improvements in RV performance.7) A strong recommendation (moderate-quality evidence) is made that pulmonary vasodilators reduce PVR andimpro
AU - Price,LC
AU - Wort,SJ
AU - Finney,SJ
AU - Marino,PS
AU - Brett,SJ
DO - 10.1186/cc9264
PY - 2010///
SN - 1364-8535
TI - Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review
T2 - Critical Care
UR - http://dx.doi.org/10.1186/cc9264
VL - 14
ER -