tailieunhanh - Pulmonary vascular and right ventricular dysfunction in adult critical care: current and emerging options for management: a systematic literature review"

Collection of reports on medical research published in international medical journals give you knowledge of medical topics: Pulmonary vascular and right ventricular dysfunction in adult critical care: current and Emerging options for management: Systematic literature review a . | Price et al. Critical Care 2010 14 R169 http content 14 5 R169 c CRITICAL CARE RESEARCH Open Access Pulmonary vascular and right ventricular dysfunction in adult critical care current and emerging options for management a systematic literature review 1 t 1t 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 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 vascular dysfunction. 5 A strong recommendation moderate-quality evidence is made that .

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