Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace / Fondazione clinica del lavoro, IRCCS [and] Istituto di clinica tisiologica e malattie apparato respiratorio, Università di Napoli, Secondo ateneo
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Monaldi Arch Chest Dis · Apr 1999
ReviewPulmonary hypertension in acute respiratory distress syndrome.
A mild degree of pulmonary hypertension is commonly observed in patients with acute respiratory distress syndrome (ARDS). Vasoconstriction plays a dominant role in increasing the mean closing pressure of the pulmonary vascular bed. Pulmonary hypertension increases right ventricular afterload, but right ventricular failure rarely occurs in patients with ARDS. ⋯ Consequently, generalized pulmonary vasodilation by intravenous vasodilators aggravates arterial hypoxaemia. Conversely, selective administration of vasodilators, such as inhaled nitric oxide, in well-ventilated lung units improves gas exchange by diverting pulmonary blood flow to better oxygenated regions. However, preliminary results from large prospective randomized controlled trials indicate that inhaled nitric oxide does not reduce mortality nor the duration of mechanical ventilation in patients with ARDS.
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This paper reviews respiratory muscle performance in patients suffering from congestive heart failure. Respiratory muscle dysfunction is well documented in these patients, and is thoroughly discussed. The mechanisms underlying its development and the potential consequences are also presented.