Positive Pressure Ventilation in Cardiogenic Shock: Review of the Evidence and Practical Advice for Patients With Mechanical Circulatory Support

Carlos L. Alviar, Juan Simon Rico-Mesa, David A. Morrow, Holger Thiele, P. Elliott Miller, Diego Jose Maselli, Sean van Diepen

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations

Abstract

Cardiogenic shock (CS) is often complicated by respiratory failure, and more than 80% of patients with CS require respiratory support. Elevated filling pressures from left-ventricular (LV) dysfunction lead to alveolar pulmonary edema, which impairs both oxygenation and ventilation. The implementation of positive pressure ventilation (PPV) improves gas exchange and can improve cardiovascular hemodynamics by reducing preload and afterload of the LV, reducing mitral regurgitation and decreasing myocardial oxygen demand, all of which can help augment cardiac output and improve tissue perfusion. In right ventricular (RV) failure, however, PPV can potentially decrease preload and increase afterload, which can potentially lead to hemodynamic deterioration. Thus, a working understanding of cardiopulmonary interactions during PPV in LV and RV dominant CS states is required to safely treat this complex and high-acuity group of patients with respiratory failure. Herein, we provide a review of the published literature with a comprehensive discussion of the available evidence on the use of PPV in CS. Furthermore, we provide a practical framework for the selection of ventilator settings in patients with and without mechanical circulatory support, induction, and sedation methods, and an algorithm for liberation from PPV in patients with CS.

Original languageEnglish (US)
Pages (from-to)300-312
Number of pages13
JournalCanadian Journal of Cardiology
Volume36
Issue number2
DOIs
StatePublished - Feb 2020

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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