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Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome

Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oed...

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Autores principales: Gierhardt, Mareike, Pak, Oleg, Walmrath, Dieter, Seeger, Werner, Grimminger, Friedrich, Ghofrani, Hossein A., Weissmann, Norbert, Hecker, Matthias, Sommer, Natascha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: European Respiratory Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489056/
https://www.ncbi.nlm.nih.gov/pubmed/34526314
http://dx.doi.org/10.1183/16000617.0059-2021
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author Gierhardt, Mareike
Pak, Oleg
Walmrath, Dieter
Seeger, Werner
Grimminger, Friedrich
Ghofrani, Hossein A.
Weissmann, Norbert
Hecker, Matthias
Sommer, Natascha
author_facet Gierhardt, Mareike
Pak, Oleg
Walmrath, Dieter
Seeger, Werner
Grimminger, Friedrich
Ghofrani, Hossein A.
Weissmann, Norbert
Hecker, Matthias
Sommer, Natascha
author_sort Gierhardt, Mareike
collection PubMed
description Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oedema, local alveolar hypoventilation and atelectasis. Inadequate perfusion of these areas is the main cause of hypoxaemia in ARDS. High perfusion in relation to ventilation (V/Q<1) and shunting (V/Q=0) is not only caused by impaired hypoxic pulmonary vasoconstriction but also redistribution of perfusion from obstructed lung vessels. Rebalancing the pulmonary vascular tone is a therapeutic challenge. Previous clinical trials on inhaled vasodilators (nitric oxide and prostacyclin) to enhance perfusion to high V/Q areas showed beneficial effects on hypoxaemia but not on mortality. However, specific patient populations with pulmonary hypertension may profit from treatment with inhaled vasodilators. Novel treatment targets to decrease perfusion in low V/Q areas include epoxyeicosatrienoic acids and specific leukotriene receptors. Still, lung protective ventilation and prone positioning are the best available standard of care. This review focuses on disturbed perfusion in ARDS and aims to provide basic scientists and clinicians with an overview of the vascular alterations and mechanisms of V/Q mismatch, current therapeutic strategies, and experimental approaches.
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spelling pubmed-94890562022-11-14 Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome Gierhardt, Mareike Pak, Oleg Walmrath, Dieter Seeger, Werner Grimminger, Friedrich Ghofrani, Hossein A. Weissmann, Norbert Hecker, Matthias Sommer, Natascha Eur Respir Rev Review Acute respiratory distress syndrome (ARDS) is a serious complication of severe systemic or local pulmonary inflammation, such as caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. ARDS is characterised by diffuse alveolar damage that leads to protein-rich pulmonary oedema, local alveolar hypoventilation and atelectasis. Inadequate perfusion of these areas is the main cause of hypoxaemia in ARDS. High perfusion in relation to ventilation (V/Q<1) and shunting (V/Q=0) is not only caused by impaired hypoxic pulmonary vasoconstriction but also redistribution of perfusion from obstructed lung vessels. Rebalancing the pulmonary vascular tone is a therapeutic challenge. Previous clinical trials on inhaled vasodilators (nitric oxide and prostacyclin) to enhance perfusion to high V/Q areas showed beneficial effects on hypoxaemia but not on mortality. However, specific patient populations with pulmonary hypertension may profit from treatment with inhaled vasodilators. Novel treatment targets to decrease perfusion in low V/Q areas include epoxyeicosatrienoic acids and specific leukotriene receptors. Still, lung protective ventilation and prone positioning are the best available standard of care. This review focuses on disturbed perfusion in ARDS and aims to provide basic scientists and clinicians with an overview of the vascular alterations and mechanisms of V/Q mismatch, current therapeutic strategies, and experimental approaches. European Respiratory Society 2021-09-15 /pmc/articles/PMC9489056/ /pubmed/34526314 http://dx.doi.org/10.1183/16000617.0059-2021 Text en Copyright ©The authors 2021 https://creativecommons.org/licenses/by-nc/4.0/This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions@ersnet.org (mailto:permissions@ersnet.org)
spellingShingle Review
Gierhardt, Mareike
Pak, Oleg
Walmrath, Dieter
Seeger, Werner
Grimminger, Friedrich
Ghofrani, Hossein A.
Weissmann, Norbert
Hecker, Matthias
Sommer, Natascha
Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title_full Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title_fullStr Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title_full_unstemmed Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title_short Impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
title_sort impairment of hypoxic pulmonary vasoconstriction in acute respiratory distress syndrome
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9489056/
https://www.ncbi.nlm.nih.gov/pubmed/34526314
http://dx.doi.org/10.1183/16000617.0059-2021
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