Pulmonary vascular and right ventricular dysfunction in adult critical care current and emerging options for management a systematic literature review 英文参考文献.docVIP

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Pulmonary vascular and right ventricular dysfunction in adult critical care current and emerging options for management a systematic literature review 英文参考文献.doc

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Pulmonary vascular and right ventricular dysfunction in adult critical care current and emerging options for management a systematic literature review 英文参考文献

Priceetal.CriticalCare2010,14:R169 /content/14/5/R169 RESEARCH OpenAccess Pulmonaryvascularandrightventricular dysfunctioninadultcriticalcare:currentand emergingoptionsformanagement:asystematic literaturereview LauraCPrice1*?,StephenJWort1?,SimonJFinney1,PhilipSMarino1,StephenJBrett2 Abstract Introduction:Pulmonaryvasculardysfunction,pulmonaryhypertension(PH),andresultingrightventricular(RV) failureoccurinmanycriticalillnessesandmaybeassociatedwithaworseprognosis.PHandRVfailuremaybe difficulttomanage:principlesincludemaintenanceofappropriateRVpreload,augmentationofRVfunction,and reductionofRVafterloadbyloweringpulmonaryvascularresistance(PVR).Wethereforeprovideadetailedupdate onthemanagementofPHandRVfailureinadultcriticalcare. Methods:Asystematicreviewwasperformed,basedonasearchoftheliteraturefrom1980to2010,byusing prespecifiedsearchterms.RelevantstudiesweresubjectedtoanalysisbasedontheGRADEmethod. Results:Clinicalstudiesofintensivecaremanagementofpulmonaryvasculardysfunctionwereidentified, describingvolumetherapy,vasopressors,sympatheticinotropes,inodilators,levosimendan,pulmonaryvasodilators, andmechanicaldevices.ThefollowingGRADErecommendations(evidencelevel)aremadeinpatientswith pulmonaryvasculardysfunction:1)Aweakrecommendation(very-low-qualityevidence)ismadethatclose monitoringoftheRVisadvisedasvolumeloadingmayworsenRVperformance;2)Aweakrecommendation(low- qualityevidence)ismadethatlow-dosenorepinephrineisaneffectivepressorinthesepatients;andthat3)low- dosevasopressinmaybeusefultomanagepatientswithresistantvasodilatoryshock.4)Aweakrecommendation (low-moderatequalityevidence)ismadethatlow-dosedobutamineimprovesRVfunctioninpulmonaryvascular dysfunction.5)Astrongrecommendation(moderate-qualityevidence)ismadethatphosphodiesterasetypeIII inhibitorsreducePVRandimproveRVfunction,althoughhypotensionisfrequent.6)Aweakrecommendation (low-qualityevidence)ismadethatlevosimendanmaybeusefulforshort-termimprovementsinRVperformance. 7)Astrongrecommendation(moderate-qualitye