Hemodynamic management in pulmonary embolism and acute hypoxemic respiratory failure.
Management of patients with the adult respiratory distress syndrome should be directed toward maintaining adequate cardiac output and tissue oxygenation without exacerbating pulmonary edema. The aim of therapy should be to maintain low left ventricular filling pressure, which will tend to decrease the rate of edema formation. If cardiac output is low or decreases as a function of therapy, flow may be increased with inotropic agents. When a marked decline in cardiac output complicates pulmonary embolism, norepinephrine may be an excellent drug for at least short-term maintenance of hemodynamic stability. When a moderate decrease in cardiac output complicates an increase in right ventricular afterload, isoproterenol or dobutamine may be used to increase flow. Rapid administration of recombinant tissue plasminogen activator may be the treatment of choice of pulmonary thromboembolism associated with a low output state.
Section of Cardiology, University of Manitoba, Winnipeg, Canada.
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Prewitt
D000208:Acute Disease; D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D002303:Cardiac Output, Low / Q000503:physiopathology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004285:Dogs; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D000860:Hypoxia / Q000503:physiopathology* / Q000628:therapy; D011655:Pulmonary Embolism / Q000503:physiopathology* / Q000628:therapy; D012128:Respiratory Distress Syndrome / Q000628:therapy; D014655:Vascular Resistance / Q000187:drug effects
D002316:Cardiotonic Agents; D005343:Fibrinolytic Agents