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10.1002/ejhf.2058

http://scihub22266oqcxt.onion/10.1002/ejhf.2058
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33200458!7753704!33200458
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suck abstract from ncbi


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pmid33200458      Eur+J+Heart+Fail 2020 ; 22 (12): 2228-2237
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  • Haemodynamic characteristics of COVID-19 patients with acute respiratory distress syndrome requiring mechanical ventilation An invasive assessment using right heart catheterization #MMPMID33200458
  • Caravita S; Baratto C; Di Marco F; Calabrese A; Balestrieri G; Russo F; Faini A; Soranna D; Perego GB; Badano LP; Grazioli L; Lorini FL; Parati G; Senni M
  • Eur J Heart Fail 2020[Dec]; 22 (12): 2228-2237 PMID33200458show ga
  • AIMS: Interstitial pneumonia due to coronavirus disease 2019 (COVID-19) is often complicated by severe respiratory failure. In addition to reduced lung compliance and ventilation/perfusion mismatch, a blunted hypoxic pulmonary vasoconstriction has been hypothesized, that could explain part of the peculiar pathophysiology of the COVID-19 cardiorespiratory syndrome. However, no invasive haemodynamic characterization of COVID-19 patients has been reported so far. METHODS AND RESULTS: Twenty-one mechanically-ventilated COVID-19 patients underwent right heart catheterization. Their data were compared both with those obtained from non-mechanically ventilated paired control subjects matched for age, sex and body mass index, and with pooled data of 1937 patients with 'typical' acute respiratory distress syndrome (ARDS) from a systematic literature review. Cardiac index was higher in COVID-19 patients than in controls [3.8 (2.7-4.5) vs. 2.4 (2.1-2.8) L/min/m(2) , P < 0.001], but slightly lower than in ARDS patients (P = 0.024). Intrapulmonary shunt and lung compliance were inversely related in COVID-19 patients (r = -0.57, P = 0.011) and did not differ from ARDS patients. Despite this, pulmonary vascular resistance of COVID-19 patients was normal, similar to that of control subjects [1.6 (1.1-2.5) vs. 1.6 (0.9-2.0) WU, P = 0.343], and lower than reported in ARDS patients (P < 0.01). Pulmonary hypertension was present in 76% of COVID-19 patients and in 19% of control subjects (P < 0.001), and it was always post-capillary. Pulmonary artery wedge pressure was higher in COVID-19 than in ARDS patients, and inversely related to lung compliance (r = -0.46, P = 0.038). CONCLUSIONS: The haemodynamic profile of COVID-19 patients needing mechanical ventilation is characterized by combined cardiopulmonary alterations. Low pulmonary vascular resistance, coherent with a blunted hypoxic vasoconstriction, is associated with high cardiac output and post-capillary pulmonary hypertension, that could eventually contribute to lung stiffness and promote a vicious circle between the lung and the heart.
  • |Aged[MESH]
  • |COVID-19/*physiopathology/therapy[MESH]
  • |Cardiac Catheterization[MESH]
  • |Cardiac Output/physiology[MESH]
  • |Case-Control Studies[MESH]
  • |Echocardiography[MESH]
  • |Female[MESH]
  • |Hemodynamics/*physiology[MESH]
  • |Humans[MESH]
  • |Hypertension, Pulmonary/*physiopathology[MESH]
  • |Hypoxia/*physiopathology/therapy[MESH]
  • |Lung Compliance/physiology[MESH]
  • |Male[MESH]
  • |Middle Aged[MESH]
  • |Respiration, Artificial[MESH]
  • |Respiratory Distress Syndrome/*physiopathology/therapy[MESH]
  • |Retrospective Studies[MESH]
  • |SARS-CoV-2[MESH]
  • |Vascular Resistance/*physiology[MESH]
  • |Vasoconstriction/*physiology[MESH]


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