• Cardioverter-defibrillator
• Echocardiography
• Global longitudinal strain
• Out-of-hospital cardiac arrest
• Right atrial area
• Right atrium area
• Survival

• acute respiratory distress syndrome
• cor pulmonale
• heart-lung crosstalk
• inflammatory mediators
• mechanical ventilation
• veno-venous ECMO

• Blood gas analysis indexes
• Laparoscopic-assisted radical gastrectomy
• Lung ultrasound score
• Pressure-controlled ventilation volume-guaranteed
• Pulmonary ventilation

• ECMO - extracorporeal membrane oxygenation
• heart-lung interactions
• monitoring
• right ventricular failure
• volume responsiveness

• COPD and left heart failure
• OSA and left heart failure
• cardiopulmonary interaction
• heart lung interactions
• left heart failure

• Acute respiratory distress syndrome
• mechanical ventilation
• personalized mechanical ventilation
• rescue therapy
• ventilator-induced lung injury

• Humans
• Respiration, Artificial
• Respiratory Distress Syndrome/therapy
• Ventilators, Mechanical
• Extracorporeal Membrane Oxygenation

In recent years, humanity has been confronted with a global pandemic due to coronavirus disease 2019 (COVID-19), which has caused an unprecedented health and economic crisis worldwide. Apart from the respiratory symptoms, which are considered the principal manifestations of COVID-19, it has been recognized that COVID-19 constitutes a systemic inflammatory process affecting multiple organ systems. Across the spectrum of organ involvement in COVID-19, acute liver injury (ALI) has been gradually gaining increasing attention by the international scientific community. COVID-19 associated liver impairment can affect a considerable proportion of COVID-19 patients and seems to correlate with the severity of the disease course. Indeed, COVID-19 patients hospitalized in the intensive care unit (ICU) run a greater risk of developing ALI due to the severity of their clinical condition and in the context of multi-organ failure. The putative pathophysiological mechanisms of COVID-19 induced ALI in ICU patients remain poorly understood and appear to be multifactorial in nature. Several theories have been proposed to explain the occurrence of ALI in the ICU setting, such as hypoperfusion and ischemia due to hemodynamic instability, passive liver congestion as a result of congestive heart failure, ischemia-reperfusion injury, hypoxia due to respiratory failure, mechanical ventilation itself, sepsis and septic shock, cytokine storm, endotheliitis with concomitant coagulopathy, drug-induced liver injury, parenteral nutrition and direct cytopathic viral effect. It should be noted that no specific therapy for COVID-19 induced ALI exists. Therefore, the therapeutic approach lies in preventive measures and is exclusively supportive once ALI ensues. The aim of the current review is to scrutinize the existing evidence on COVID-19 associated ALI in ICU patients, explore its clinical implications, shed light on the underlying pathophysiological mechanisms and propose potential therapeutic approaches. Ongoing research on the particular scientific field will further elucidate the pathophysiology behind ALI and address unresolved issues, in the hope of mitigating the tremendous health consequences imposed by COVID-19 on ICU patients.

• Liver injury
• COVID-19
• Intensive care
• Pathophysiological mechanisms
• Cytokine storm
• Multi-organ failure

• Humans
• COVID-19/complications
• SARS-CoV-2
• Intensive Care Units
• Shock, Septic
• Liver

• cardiac monitoring
• cardio-mechanical signals
• cardio-respiratory interaction
• forcecardiography
• mechanocardiography
• respiration
• systolic time intervals

• Heart Rate
• Respiratory Rate
• Heart
• Ballistocardiography
• Stroke Volume

Prolonged mechanical ventilation in children undergoing cardiac surgery is related to the decrease in cardiac output. The pressure recording analytical method (PRAM) is a minimally invasive system for continuous hemodynamic monitoring. To evaluate the postoperative prognosis, our study explored the predictive value of hemodynamic management for the duration of mechanical ventilation (DMV).

This retrospective study included 60 infants who underwent cardiac surgery. Cardiac index (CI), the maximal slope of systolic upstroke (dp/dt_max), and cardiac cycle efficiency (CCE) derived from PRAM were documented in each patient 0, 4, 8, and 12 h (T0, T1, T2, T3, and T4, respectively) after their admission to the intensive care unit (ICU). A linear mixed model was used to deal with the hemodynamic data. Correlation analysis, receiver operating characteristic (ROC), and a XGBoost machine learning model were used to find the key factors for prediction.

Linear mixed model revealed time and group effect in CI and dp/dt_max. Prolonged DMV also have negative correlations with age, weight, CI at and dp/dt_max at T2. dp/dt_max outweighing CI was the strongest predictor (AUC of ROC: 0.978 vs. 0.811, p < 0.01). The machine learning model suggested that dp/dt_max at T2 ≤ 1.049 or < 1.049 in combination with CI at T0 ≤ 2.0 or >2.0 can predict whether prolonged DMV (AUC of ROC = 0.856).

Cardiac dysfunction is associated with a prolonged DMV with hemodynamic evidence. CI measured by PRAM immediately after ICU admission and dp/dt_max 8h later are two key factors in predicting prolonged DMV.

Refractory hypoxemia after right ventricular myocardial infarction and concomitant SARS-CoV-2 infection represents an uncommon, yet particularly challenging clinical scenario. We report a challenging diagnostic case of refractory hypoxemia due to right-to-left shunt highlighting contemporary challenges and pitfalls in acute cardiovascular care associated with the current COVID-19 pandemic.

A 52-year-old patient admitted for inferior acute myocardial infarction developed rapidly worsening hypoxemia shortly after primary percutaneous coronary intervention. RT-PCR screening for SARS-CoV-2 was positive, even though the patient had no prior symptoms. A computed tomography pulmonary angiogram excluded pulmonary embolism and showed only mild interstitial pulmonary involvement of the virus. Transthoracic echocardiogram showed severe right ventricular dysfunction and significant right-to-left shunt at the atrial level after agitated saline injection. Progressive improvement of right ventricular function allowed weaning from supplementary oxygen support. Patient was latter discharged with marked symptomatic improvement.

Refractory hypoxemia after RV myocardial infarction should be carefully addressed, even in the setting of other more common and tempting diagnoses. After exclusion of usual etiologies, right-to-left shunting at the atrial level should always be suspected, as this may avoid unnecessary and sometimes harmful interventions.

The online version contains supplementary material available at 10.1186/s12872-022-02765-9.

• 2019-novel coronavirus pneumonia
• Case report
• Foramen ovale, patent
• Hypoxemia
• Myocardial infarction

Acute respiratory distress syndrome (ARDS) is an acute, diffuse, inflammatory lung injury. Previous studies have shown prone position ventilation (PPV) to be associated with improvement in oxygenation. However, its role in patients with ARDS caused by sepsis remains unknown.

To analyze the clinical effects of PPV in patients with ARDS caused by sepsis.

One hundred and two patients with ARDS were identified and divided into a control group (n = 55) and a PPV treatment group (n = 47). Outcomes included oxygenation index, lung compliance (Cst) and platform pressure (Pplat), which were compared between the two groups after ventilation. Other outcomes included heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), left ventricular ejection fraction (LVEF), the length of mechanical ventilation time and intensive care unit (ICU) stay, and levels of C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) after ventilation. Finally, mortality rate was also compared between the two groups.

On the first day after ventilation, the oxygenation index and Cst were higher and Pplat level was lower in the PPV group than in the conventional treatment group (P < 0.05). There were no significant differences in oxygenation index, Cst, and Pplat levels between the two groups on the 2^nd, 4^th, and 7^th day after ventilation (P > 0.05). There were no significant differences in HR, MAP, CVP, LVEF, duration of mechanical ventilation and ICU stay, and the levels of CRP, PCT, and IL-6 between the two groups on the first day after ventilation (all P > 0.05). The mortality rates on days 28 and 90 in the PPV and control groups were 12.77% and 29.09%, and 25.53% and 45.45%, respectively (P < 0.05).

PPV may improve respiratory mechanics indices and may also have mortality benefit in patients with ARDS caused by sepsis. Finally, PPV was not shown to cause any adverse effects on hemodynamics and inflammation indices.

• Acute respiratory distress syndrome
• Sepsis
• Prone position
• Supine position
• Mechanical ventilation
• Hemodynamics

Frequency-based measures of heart rate variability have been shown to be a useful physiological marker in both clinical and research settings providing insight into the functioning of the autonomic nervous system. Ongoing interactions between the autonomic nervous system control of the heart and lung occurs during each ventilation cycle because of their anatomical position within the closed thoracic cavity. Mechanical ventilation and subsequent removal change the normal ventilator mechanics producing alterations in the tidal volume, intrathoracic pressure, and oxygen delivery. A noninvasive method called heart rate variability (HRV) can be used to evaluate this interaction during ventilation and can be quantified by applying frequency-based measures of the variability between heartbeats. Although HRV is a reliable method to measure alteration of the autonomic nervous system (ANS) function and cardiopulmonary interaction, there have been limited reports concerning the changes in the frequency-based measure of HRV during both spontaneous and mechanical ventilation. The purpose of this methodological study is therefore to describe the physiological influence of both spontaneous and mechanical ventilation on frequency-based measures of HRV.

• COPD
• NIV
• dynamic hyperinflation
• exercise
• opto-electronic plethysmography

• acute lung injury
• arrhythmogenesis
• autonomic dysfunction
• cardiopulmonary afferents
• neural inflammation
• sympatho-excitation

• anaesthesia
• pathophysiology
• perioperative care
• pulmonary hypertension

• afterload
• pulse pressure variation
• right heart failure
• right ventricle
• volume responsiveness

• ARDS
• NIPPV
• NPV
• PNSV
• alveolar pressure (PA)
• cuirass
• iron-lung
• negative pressure (Pneg)
• ponchowrap
• transpulmonary pressure (PL)

In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique.

The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed.

Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease.

The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.

• STRIVE Hi
• anesthesia
• laryngomalacia
• pediatric airway management
• supraglottoplasty
• surgical procedure

Stroke volume measurement should provide estimates of acute treatment responses. The current pulse contour method estimates left ventricle stroke volume. Heart-lung interactions change right ventricular stroke volume acutely. We investigated the accuracy, precision, and trending abilities of four calibrated stroke volume estimates based on pulmonary artery pulse contour analysis.

Stroke volume was measured in 9 pigs with a pulmonary artery ultrasound flow probe at 5 and 10 cmH₂O of PEEP and three volume states (baseline, bleeding, and retransfusion) and compared against stroke volume estimates of four calibrated pulmonary pulse contour algorithms based on pulse pressure or pressure integration. Bland-Altman comparison with correction for multiple measurements and trend analysis were performed. Heart rate and stroke volumes were 104 ± 24 bpm and 30 ± 12 mL, respectively. The stroke volume estimates had a minimal bias: − 0.11 mL (95% CI − 0.55 to 0.33) to 0.32 mL (95% CI − 0.06 to 0.70). The limits of agreement were − 8.0 to 7.8 mL for calibrated pulse pressure to − 10.4 to 11.5 mL for time corrected pressure integration, resulting in a percentage error of 36 to 37%. The calibrated pulse pressure method performed best. Changes in stroke volume were trended very well (concordance rates 73–100%, r² 0.26 to 0.987, for pulse pressure methods and 71–100%, r² 0.236 to 0.977, for integration methods).

Pulmonary artery pulse contour methods reliably detect acute changes in stroke volume with good accuracy and moderate precision and accurately trend short-term changes in cardiac output over time.

• Pulse contour analysis
• Right ventricle
• Stroke volume

• Critical care
• Intensive care
• Natriuretic peptide (brain)
• Respiration (artificial)
• Ventilator weaning

• Adult
• Child
• Critical Illness
• Humans
• Natriuretic Peptide, Brain
• Prospective Studies
• Respiration, Artificial
• Ventilator Weaning

• Not applicable Strategy for Patient Oriented Research (SP OR) SUPPORT Unit - Knowledge Translation Platform.

Lung-protective ventilation and prolonged prone positioning (PP) are presented as essential in treating acute respiratory distress syndrome (ARDS). The optimal respirator mode, however, remains controversial. Pressure-supported spontaneous breathing (PS) during ARDS provides several advantages, but is difficult to achieve during PP because of respiratory depression as a side effect of sedative drugs. This study was designed to evaluate the feasibility and safety of PS during PP in ARDS patients sedated with inhaled sevoflurane.

Overall, we have observed 4339 h of prone positioning in 62 patients who had a median of four prone episodes during treatment. Within 3948 h (91%), patients were successfully brought into a pressure-supported spontaneous breathing mode. The median duration of each prone episode was 17 h (IQR 3). Median duration of pressure-supported spontaneous breathing per episode was 16 h (IQR 5). Just one self-extubation occurred during 276 episodes of PP.

Pressure-supported spontaneous breathing during prolonged prone positioning in intubated ARDS patients with or without ECMO can be achieved during volatile sedation with sevoflurane. This finding may provide a basis upon which to question the latest dogma in ARDS treatment. Our concept must be further investigated and compared to controlled ventilation with regard to driving pressure, lung-protective parameters, muscle weakness and mortality before it can be routinely applied.

• ARDS
• ECMO
• Prone positioning
• Sedation
• Sevoflurane
• Spontaneous breathing
• Volatile anesthesia

• artificial
• brain
• critical care
• intensive care
• natriuretic peptide
• respiration
• ventilator weaning

• Humans
• Biomarkers/blood
• Critical Illness/therapy
• Natriuretic Peptide, Brain/blood
• Predictive Value of Tests
• Ventilator Weaning/methods
• Meta-Analysis as Topic
• Systematic Reviews as Topic

• Alberta Strategy for Patient Oriented Research (SPOR) SUPPORT Unit - Knowledge Translation Platform.

• Cardiac
• haemodynamics
• respiratory

• Afterload
• heart-lung interactions
• preload
• ventricular interdependence

• Venous return
• mean systemic filling pressure
• right atrial pressure (RAP)
• stressed volume