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RV-failure in septic shock

added by Emmel

RV-failure in septic shock
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Posted By: Emmel (997 days ago)

Hello Pablo,

Thanks for comment.
You´re definitely
right! recruitment-maneuvre could be a problem for RV-failure. We
tried to recruit that region of alveoli to improve oxygenation. CO2
wasn´t a problem, so we decided not to implantate the ILA- novalung.
Prone position showed no improvement of oxygenation and RV-Failure./>
Thanks a lot for your comment and hints,
Jörg.

Posted By: ohtusabes (997 days ago)

Amazing video.

We talk about it in another video.
One
thing to say is recruitment maneuver are formally contraindicated in
this patient, simply because elevate RV afterload is terrible for
RV.
Prone position will unload RV? I consider this approach,
specially if hypoxemia is a problem and in fact, is a problem for RV
afterload.

Best
Pablo


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Emmel

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Added: 13-01-2012
Runtime: 0m 30s
Views: 3561
Comments: 2

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Description

about 85 y old patient with known chronic RV-failure; actually the patient was admitted to our ICU from another ER with syncope and dyspnoea. NIV wasn´t effective, so we had to intubate and mechanically ventilate the patient. In bronchoscopy we found a severe pulmonary infection in lower left lung (gram-stain: gram-negative rod cell and gram-positive coccal). The patient needed high-dose catecholamines (norepinephrin, dobutamine, milrinon, amiodarone,pitressin, hydrocortisone); CVP of 13 > after volume CVP of 17 without profit of haemodynamic. In TTE and TEE we saw a RV-overpressure with systolic septum-shift and no undulation of VCI: in TEE: no sign of thrombus in LAA, RAA or PA. besides we could see the pulmonary consolidation lower left lung despite of former bronchoscopy. volume-challenge wasn´t effective; over the course of time the patient was catecholamine-refraktory. What do you think? Any other options in therapeutical treatment of RV-failure?


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