Acute Pulmonary Embolism Decreases Adenosine Plasma Levels in Anesthetized Pigs

Adenosine plays a role in pulmonary arterial (PA) resistance due to its vasodilator properties. However, the behavior of adenosine plasma levels (APLs) during pulmonary embolism remains unknown. We investigated the effects of gradual pulmonary embolism on right ventricular (RV) contractility and PA coupling and on APLs in an piglet experimental model of RV failure. PA distal resistance by pressure-flow relationships and pulmonary vascular impedance were measured. RV contractility was determined by the end-systolic pressure-volume relationship (Ees), PA effective elastance by the end-diastolic to end-systolic relationship (Ea), and RV-PA coupling efficiency by the Ees/Ea ratio. APLs were measured before and during gradual pulmonary embolization. PA embolism increased PA resistance and elastance, increased Ea from 1.08 ± 0.15 to 5.62 ± 0.32 mmHg/mL, decreased Ees from 1.82 ± 0.10 to 1.20 ± 0.23 mmHg/mL, and decreased Ees/Ea from 1.69 ± 0.15 to 0.21 ± 0.07. APLs decreased from 2.7 ± 0.26 to 1.3 ± 0.12 μM in the systemic bed and from 4.03 ± 0.63 to 2.51 ± 0.58 μM in the pulmonary bed during embolism procedure. Pulmonary embolism worsens PA hemodynamics and RV-PA coupling. APLs were reduced, both in the systemic and in the pulmonary bed, leading then to pulmonary vasoconstriction

Ventricular-arterial uncoupling in heart failure with preserved ejection fraction after myocardial infarction in dogs - invasive versus echocardiographic evaluation

Heart failure with preserved left ventricular ejection fraction and abnormal diastolic function is commonly observed after recovery from an acute myocardial infarction. The aim of this study was to investigate the physiopathology of heart failure with preserved ejection fraction in a model of healed myocardial infarction in dogs.Journal ArticleResearch Support, Non-U.S. Gov'tSCOPUS: ar.jinfo:eu-repo/semantics/publishe

Acid-base status and pulmonary circulation

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Les modes en volume, les specificites du monitorage et des alarmes

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Physiology in medicine: Importance of hypoxic pulmonary vasoconstriction in maintaining arterial oxygenation during acute respiratory failure

SCOPUS: re.jinfo:eu-repo/semantics/publishe

Effects of metabolic alkalosis on pulmonary gas exchange.

In order to investigate whether the changes in PaO2 reported during acid-base disturbances are due to modifications of ventilation/perfusion relationships or only to extrapulmonary factors, we studied the hemodynamics and blood gases of eight critically ill patients maintained in constant mechanical ventilation, before and after selective correction of metabolic alkalosis by infusion of 1 N hydrochloric acid (HCl). HCl infusion decreased arterial pH from 7.55 to 7.40 (p less than 0.001) and increased PaO2 from 76 to 98 mm Hg (p less than 0.05) at the end of the study. Cardiac output and oxygen consumption did not change. In patients with initial venous admixture (QS/QT) less than 20% (n = 4), QS/QT did not change, and hemoglobin saturation decreased, whereas PaO2 increased from 87 to 96 mm Hg (p less than 0.10), indicating a shift in the oxyhemoglobin dissociation curve caused by the Bohr effect. In patients with QS/QT greater than 20% (n = 4), QS/QT decreased from 27 to 22% (p less than 0.05), hemoglobin saturation increased from 93 to 96% (p less than 0.05), and PaO2 increased from 65 to 100 mm Hg (p less than 0.05), which reflects an improvement in ventilation/perfusion relationships, probably because of enhanced hypoxic pulmonary vasoconstriction. These data indicate that metabolic alkalosis deteriorates pulmonary ventilation/perfusion relationships in patients with marked respiratory failure (QS/QT greater than 20%), and that reversing this effect with HCl infusion can improve PaO2 significantly.Journal Articleinfo:eu-repo/semantics/publishe

Correct position of the pumonary artery catheter

info:eu-repo/semantics/publishe

A clinical data management system for critically ill patients

SCOPUS: NotDefined.jinfo:eu-repo/semantics/publishe

Non-Heart-Beating Donation: Ethical Aspects

Non-heart-beating donation (NHBD) is under considerable ethical debate including concerns that the donor is not really dead when organs are procured and that withdrawing therapy may be expedited to harvest needed organs. We suggest a two-step process to NHBD based largely on the ethical principle of beneficence. First, once a decision has been made that there is no reasonable hope of survival for the patient and that active treatment is of no further benefit and should be withdrawn, NHBD can be suggested. Second, once the decision for NHBD has been made, there is no reason for further delay and withdrawal of treatment should be implemented as rapidly as possible to ensure that the quality of the donated organs remains optimal for the maximal benefit of the organ recipient. © 2009 Elsevier Inc. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Left and right ventriculo-arterial coupling in a patient with congenitally corrected transposition

SCOPUS: ar.jinfo:eu-repo/semantics/publishe