Seminars in respiratory and critical care medicine最新文献_第7页

Radiological Diagnosis of Pulmonary Aspergillosis. 肺曲霉菌病的放射学诊断。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2024-02-01 Epub Date: 2024-01-29 DOI: 10.1055/s-0043-1776998

François Laurent, Ilyes Benlala, Gael Dournes

引用次数: 0

Extracorporeal Life Support in Pulmonary Hypertension: Practical Aspects. 肺动脉高压的体外生命支持：实践方面。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-09-14 DOI: 10.1055/s-0043-1772752

Marius M Hoeper

引用次数: 0

Management of Pulmonary Hypertension Associated with Chronic Lung Disease. 与慢性肺病相关的肺动脉高压的治疗。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-07-24 DOI: 10.1055/s-0043-1770121

Isabel Blanco, Fernanda Hernández-González, Agustín García, Rodrigo Torres-Castro, Joan A Barberà

{"title":"Management of Pulmonary Hypertension Associated with Chronic Lung Disease.","authors":"Isabel Blanco, Fernanda Hernández-González, Agustín García, Rodrigo Torres-Castro, Joan A Barberà","doi":"10.1055/s-0043-1770121","DOIUrl":"10.1055/s-0043-1770121","url":null,"abstract":"Pulmonary hypertension (PH) is a common complication of chronic lung diseases, particularly in chronic obstructive pulmonary disease (COPD) and interstitial lung diseases (ILD) and especially in advanced disease. It is associated with greater mortality and worse clinical course. Given the high prevalence of some respiratory disorders and because lung parenchymal abnormalities might be present in other PH groups, the appropriate diagnosis of PH associated with respiratory disease represents a clinical challenge. Patients with chronic lung disease presenting symptoms that exceed those expected by the pulmonary disease should be further evaluated by echocardiography. Confirmatory right heart catheterization is indicated in candidates to surgical treatments, suspected severe PH potentially amenable with targeted therapy, and, in general, in those conditions where the result of the hemodynamic assessment will determine treatment options. The treatment of choice for these patients who are hypoxemic is long-term oxygen therapy and pulmonary rehabilitation to improve symptoms. Lung transplant is the only curative therapy and can be considered in appropriate cases. Conventional vasodilators or drugs approved for pulmonary arterial hypertension (PAH) are not recommended in patients with mild-to-moderate PH because they may impair gas exchange and their lack of efficacy shown in randomized controlled trials. Patients with severe PH (as defined by pulmonary vascular resistance >5 Wood units) should be referred to a center with expertise in PH and lung diseases and ideally included in randomized controlled trials. Targeted PAH therapy might be considered in this subset of patients, with careful monitoring of gas exchange. In patients with ILD, inhaled treprostinil has been shown to improve functional ability and to delay clinical worsening.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9866178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Diagnostic Approach to Pulmonary Hypertension. 肺动脉高压的诊断方法。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-07-24 DOI: 10.1055/s-0043-1770116

Adam Torbicki, Marcin Kurzyna

{"title":"The Diagnostic Approach to Pulmonary Hypertension.","authors":"Adam Torbicki, Marcin Kurzyna","doi":"10.1055/s-0043-1770116","DOIUrl":"10.1055/s-0043-1770116","url":null,"abstract":"The clinical presentation of pulmonary hypertension (PH) is nonspecific, resulting in significant delays in its detection. In the majority of cases, PH is a marker of the severity of other cardiopulmonary diseases. Differential diagnosis aimed at the early identification of patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) who do require specific and complex therapies is as important as PH detection itself. Despite all efforts aimed at the noninvasive assessment of pulmonary arterial pressure, the formal confirmation of PH still requires catheterization of the right heart and pulmonary artery. The current document will give an overview of strategies aimed at the early diagnosis of PAH and CTEPH, while avoiding their overdiagnosis. It is not intended to be a replica of the recently published European Society of Cardiology (ESC) and European Respiratory Society (ERS) Guidelines on Diagnosis and Treatment of Pulmonary Hypertension, freely available at the Web sites of both societies. While promoting guidelines' recommendations, including those on new definitions of PH, we will try to bring them closer to everyday clinical practice, benefiting from our personal experience in managing patients with suspected PH.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9868174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medical Emergencies in Pulmonary Hypertension. 肺动脉高压的医疗急救。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-08-18 DOI: 10.1055/s-0043-1770120

Samuel Seitler, Konstantinos Dimopoulos, Sabine Ernst, Laura C Price

{"title":"Medical Emergencies in Pulmonary Hypertension.","authors":"Samuel Seitler, Konstantinos Dimopoulos, Sabine Ernst, Laura C Price","doi":"10.1055/s-0043-1770120","DOIUrl":"10.1055/s-0043-1770120","url":null,"abstract":"The management of acute medical emergencies in patients with pulmonary hypertension (PH) can be challenging. Patients with preexisting PH can rapidly deteriorate due to right ventricular decompensation when faced with acute physiological challenges that would usually be considered low-risk scenarios. This review considers the assessment and management of acute medical emergencies in patients with PH, encompassing both pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH), acknowledging these comprise the more severe groups of PH. Management protocols are described in a systems-based approach. Respiratory emergencies include pulmonary embolism, airways disease, and pneumonia; cardiac emergencies including arrhythmia and chest pain with acute myocardial infarction are discussed, alongside PH-specific emergencies such as pulmonary artery dissection and extrinsic coronary artery compression by a dilated proximal pulmonary artery. Other emergencies including sepsis, severe gastroenteritis with dehydration, syncope, and liver failure are also considered. We propose management recommendations for medical emergencies based on available evidence, international guidelines, and expert consensus. We aim to provide advice to the specialist alongside the generalist, and emergency doctors, nurses, and acute physicians in nonspecialist centers. A multidisciplinary team approach is essential in the management of patients with PH, and communication with local and specialist PH centers is paramount. Close hemodynamic monitoring during medical emergencies in patients with preexisting PH is vital, with early referral to critical care recommended given the frequent deterioration and high mortality in this setting.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10381607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Updated Hemodynamic Definition and Classification of Pulmonary Hypertension. 肺动脉高压的最新血液动力学定义和分类。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-08-18 DOI: 10.1055/s-0043-1770115

Benoit Lechartier, Mithum Kularatne, Xavier Jaïs, Marc Humbert, David Montani

引用次数: 0

Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension. 肺动脉高压专题：慢性血栓栓塞性肺动脉高压的医学和介入治疗。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-08-11 DOI: 10.1055/s-0043-1770122

Marion Delcroix, Catharina Belge, Geert Maleux, Laurent Godinas

{"title":"Monographic Issue on Pulmonary Hypertension: Medical and Interventional Treatment for Chronic Thromboembolic Pulmonary Hypertension.","authors":"Marion Delcroix, Catharina Belge, Geert Maleux, Laurent Godinas","doi":"10.1055/s-0043-1770122","DOIUrl":"10.1055/s-0043-1770122","url":null,"abstract":"Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism. The reasons why clots do not resorb are incompletely understood, but the result is partial or complete fibrothrombotic obstruction of pulmonary arteries. A secondary microvasculopathy aggravates the pulmonary hypertension (PH) as a consequence of high flow and shear stress in the nonoccluded arteries. The treatment of CTEPH has long been purely surgical, but many patients were inoperable because of inaccessible lesions or severe comorbidities. Alternatives were developed, including medical therapy and more recently balloon pulmonary angioplasty (BPA). Depending on the generation of the obstructed vessels, the treatment will be surgical, up to the (sub)segmental level, or by BPA for more distal vessels. PH drugs are used to treat the microvasculopathy. The current paper describes the therapeutic management of inoperable patients: the medical approach with PH drugs used in mono- or combination therapy; the proper use of anticoagulants in CTEPH; the technique, indications, and results at short- and long-term of BPA; the multimodal approach for inoperable patients combining PH drugs and BPA; and the effects of rehabilitation. It shows the importance of a multidisciplinary approach to the disease.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgery and Anesthesia in Patients with Pulmonary Hypertension. 肺动脉高压患者的手术和麻醉。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-09-20 DOI: 10.1055/s-0043-1772753

Robin Condliffe, Ruth Newton, Kris Bauchmuller, Tessa Bonnett, Robert Kerry, Alexa Mannings, Amanda Nair, Karen Selby, Paul P Skinner, Victoria J Wilson, David G Kiely

引用次数: 0

Monographic Issue on Pulmonary Hypertension. 肺动脉高压专题。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-10-30 DOI: 10.1055/s-0043-1772751

Joan Albert Barberà, Marc Humbert

引用次数: 0

The Right Ventricle in Pulmonary Hypertension. 肺动脉高压的右心室。

IF 3.2 3区医学

Seminars in respiratory and critical care medicine Pub Date : 2023-12-01 Epub Date: 2023-07-24 DOI: 10.1055/s-0043-1770117

Jeroen N Wessels, Lucas R Celant, Frances S de Man, Anton Vonk Noordegraaf

{"title":"The Right Ventricle in Pulmonary Hypertension.","authors":"Jeroen N Wessels, Lucas R Celant, Frances S de Man, Anton Vonk Noordegraaf","doi":"10.1055/s-0043-1770117","DOIUrl":"10.1055/s-0043-1770117","url":null,"abstract":"The right ventricle plays a pivotal role in patients with pulmonary hypertension (PH). Its adaptation to pressure overload determines a patient's functional status as well as survival. In a healthy situation, the right ventricle is part of a low pressure, high compliance system. It is built to accommodate changes in preload, but not very well suited for dealing with pressure overload. In PH, right ventricular (RV) contractility must increase to maintain cardiac output. In other words, the balance between the degree of RV contractility and afterload determines stroke volume. Hypertrophy is one of the major hallmarks of RV adaptation, but it may cause stiffening of the ventricle in addition to intrinsic changes to the RV myocardium. Ventricular filling becomes more difficult for which the right atrium tries to compensate through increased stroke work. Interaction of RV diastolic stiffness and right atrial (RA) function determines RV filling, but also causes vena cava backflow. Assessment of RV and RA function is critical in the evaluation of patient status. In recent guidelines, this is acknowledged by incorporating additional RV parameters in the risk stratification in PH. Several conventional parameters of RV and RA function have been part of risk stratification for many years. Understanding the pathophysiology of RV failure and the interactions with the pulmonary circulation and right atrium requires consideration of the unique RV anatomy. This review will therefore describe normal RV structure and function and changes that occur during adaptation to increased afterload. Consequences of a failing right ventricle and its implications for RA function will be discussed. Subsequently, we will describe RV and RA assessment in clinical practice.","PeriodicalId":21727,"journal":{"name":"Seminars in respiratory and critical care medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9866183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0