Pulmonary hypertension in ARDS: inflammation matters!

The recognition of pulmonary vascular complications in acute respiratory distress syndrome (ARDS) spans more than 40 years. Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure of ≥25 mm Hg at right heart catheterisation. PH is a recognised consequence of ARDS, with a high prevalence in early studies. The pathogenesis of PH in ARDS is likely to be multifactorial and disease stage-dependent. Further to the modifiable effects of positive pressure ventilation,1 potential underlying mechanisms of PH in ARDS include vessel obliteration, microthrombosis and pulmonary vasoconstriction due to hypoxia, hypercapnia and vasoactive mediator imbalance. Pulmonary vascular remodelling occurs later.2 Sepsis-related right-sided and also left-sided ventricular myocardial dysfunction may also contribute. Whatever the cause of PH, the resulting right ventricular (RV) dysfunction is associated with increased morbidity and mortality,3 4 although it is not actually proven that RV failure is a mode of death...

Source: Thorax - April 10, 2017 Category: Respiratory Medicine Authors: Price, L. C., Wort, S. J. Tags: Editorials Source Type: research