Complex Heart–Lung Ventilator Emergencies in the CICU - 16/04/24

Doi : 10.1016/j.ccl.2024.02.010

Mireia Padilla Lopez, MD ^a, Willard Applefeld, MD ^b, P. Elliott Miller, MD, MHS ^c, Andrea Elliott, MD ^d, Courtney Bennett, DO ^e, Burton Lee, MD ^f, Christopher Barnett, MD, MPH ^g, Michael A. Solomon, MD, MBA ^h, Francesco Corradi, MD, PhD ⁱ, Alessandro Sionis, MD ^a, Eduardo Mireles-Cabodevila, MD ^j, Guido Tavazzi, MD, PhD ^k, Carlos L. Alviar, MD ^l,^⁎
^a Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
^b Division of Cardiology, Duke University Medical Center, Durham, NC, USA
^c Division of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
^d Division of Cardiology, University of Minnesota, Minneapolis, MN, USA
^e Heart and Vascular Institute, Leigh Valley Health Network, Allentown, PA, USA
^f Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MA, USA
^g Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
^h Clinical Center and Cardiology Branch, Critical Care Medicine Department, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MA, USA
ⁱ Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
^j Respiratory Institute, Cleveland Clinic, Ohio and the Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
^k Department of Critical Care Medicine, Intensive Care Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
^l The Leon H. Charney Division of Cardiovascular Medicine, New York University School of Medicine, USA

^∗Corresponding author. 462 First Avenue, Suite 10W17, New York, NY 10016.462 First Avenue, Suite 10W17New YorkNY10016

Résumé

This review aims to enhance the comprehension and management of cardiopulmonary interactions in critically ill patients with cardiovascular disease undergoing mechanical ventilation. Highlighting the significance of maintaining a delicate balance, this article emphasizes the crucial role of adjusting ventilation parameters based on both invasive and noninvasive monitoring. It provides recommendations for the induction and liberation from mechanical ventilation. Special attention is given to the identification of auto-PEEP (positive end-expiratory pressure) and other situations that may impact hemodynamics and patients’ outcomes.

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Keywords : Cardiopulmonary interactions, Mechanical ventilation, Hemodynamics, Cardiogenic shock