Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution
Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is crit...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-09-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/11/10/900 |
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| author | René López Rodrigo Pérez-Araos Álvaro Salazar Ana L. Ulloa Cecilia Vial Pablo A. Vial Jerónimo Graf |
| author_facet | René López Rodrigo Pérez-Araos Álvaro Salazar Ana L. Ulloa Cecilia Vial Pablo A. Vial Jerónimo Graf |
| author_sort | René López |
| collection | DOAJ |
| description | Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, <i>r</i> = 0.20) and negatively with mean arterial pressure (<i>r</i> = −0.27) and GEF (<i>r</i> = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (<i>r</i> = 0.31) and negatively with cardiac index (<i>r</i> = −0.49), end-diastolic volume (<i>r</i> = −0.48), and GEF (<i>r</i> = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment. |
| first_indexed | 2024-12-20T14:37:08Z |
| format | Article |
| id | doaj.art-1dbd71dd0a7d4b10ae59a68cfb3a694a |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-12-20T14:37:08Z |
| publishDate | 2019-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-1dbd71dd0a7d4b10ae59a68cfb3a694a2022-12-21T19:37:26ZengMDPI AGViruses1999-49152019-09-01111090010.3390/v11100900v11100900Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary ThermodilutionRené López0Rodrigo Pérez-Araos1Álvaro Salazar2Ana L. Ulloa3Cecilia Vial4Pablo A. Vial5Jerónimo Graf6Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, ChileDepartamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, ChileDepartamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, ChileDepartamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, ChilePrograma Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, ChileEscuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, ChileDepartamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, ChileHantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, <i>r</i> = 0.20) and negatively with mean arterial pressure (<i>r</i> = −0.27) and GEF (<i>r</i> = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (<i>r</i> = 0.31) and negatively with cardiac index (<i>r</i> = −0.49), end-diastolic volume (<i>r</i> = −0.48), and GEF (<i>r</i> = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment.https://www.mdpi.com/1999-4915/11/10/900hantavirus cardiopulmonary syndromehantavirus pulmonary syndrometranspulmonary thermodilutionpulmonary edemaandes virus |
| spellingShingle | René López Rodrigo Pérez-Araos Álvaro Salazar Ana L. Ulloa Cecilia Vial Pablo A. Vial Jerónimo Graf Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution Viruses hantavirus cardiopulmonary syndrome hantavirus pulmonary syndrome transpulmonary thermodilution pulmonary edema andes virus |
| title | Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution |
| title_full | Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution |
| title_fullStr | Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution |
| title_full_unstemmed | Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution |
| title_short | Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution |
| title_sort | hemodynamic and pulmonary permeability characterization of hantavirus cardiopulmonary syndrome by transpulmonary thermodilution |
| topic | hantavirus cardiopulmonary syndrome hantavirus pulmonary syndrome transpulmonary thermodilution pulmonary edema andes virus |
| url | https://www.mdpi.com/1999-4915/11/10/900 |
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