pulmonary vascular and right ventricular dysfunction in adult critical care current and emerging options for management a systematic literature review肺血管和右心室功能障碍在成人重症监护当前和新兴的选择管理系统的文献回顾.pdfVIP

Price et al. Critical Care 2010, 14:R169 /content/14/5/R169 RESEARCH Open Access Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review 1*† 1† 1 1 2 Laura C Price , Stephen J Wort , Simon J Finney , Philip S Marino , Stephen J Brett Abstract 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 be difficult to manage: principles include maintenance of appropriate RV preload, augmentation of RV function, and reduction of RV afterload by lowering pulmonary vascular resistance (PVR). We therefore provide a detailed update on 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 using prespecified 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 with pulmonary vascular dysfunction: 1) A weak recommendation (very-low-quality evidence) is made that close monitoring of the RV is advised as volume loading may worsen RV performance; 2) A weak recommendation (low- quality evidence) is made that low-dose norepinephrine is an effective pressor in these patients; and that 3) low- dose vasopressin may