Positive Pressure Ventilation in Cardiogenic Shock: Review of the Evidence and Practical Advice for Patients with Mechanical Circulatory Support

Publication date: Available online 12 December 2019Source: Canadian Journal of CardiologyAuthor(s): Carlos L. Alviar, Juan Simon Rico-Mesa, David A. Morrow, Holger Thiele, P. Elliott Miller, Diego Jose Maselli, Sean van DiepenAbstractCardiogenic shock (CS) is often complicated by respiratory failure and over 80% of patient with CS require respiratory support. Elevated filling pressures from left ventricular (LV) dysfunction lead to alveolar pulmonary edema which impairs both oxygenation and ventilation. The implementation of positive pressure ventilation (PPV) improves gas exchange and can improve cardiovascular hemodynamics by reducing preload and afterload of the left ventricle (LV), reducing mitral regurgitation, and decreasing myocardial oxygen demand; all of which can help augment cardiac output and improve tissue perfusion. In right ventricular (RV) failure, however, PPV can potentially decrease preload and increase afterload, which can potentially lead to hemodynamic deterioration. Thus, a working understanding of cardio-pulmonary interactions during PPV in LV and RV dominant CS states is required to safely treat this complex and high-acuity group of patients with respiratory failure. Herein, we provide a review of the published literature with a comprehensive discussion of the available evidence on the use of PPV in CS. Furthermore, we provide a practical framework for the selection of ventilator settings in patients with and without mechanical circulatory support, in...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research