[HSF] RV failure management strategies

[prasannasimha]

I used NO but it did not make much of a difference so I switched to 
inhaled sodium nitroprusside which had similar effects.
Prasanna
Giuseppe Rescigno wrote:
> Is the NO available in your hospital? Sometimes it is an effective ajunct to what your are already doing. 
>
> Giuseppe
>
> Giuseppe Rescigno M.D.
> Cardiothoracic Surgeon
>
> Lancisi Hospital
> Torrette - Ancona
> Italy
>
>
>  
> On Friday, December 01, 2006, at 03:40AM, "prasannasimha" <prasannasimha at gmail.com> wrote:
>   
>> Can the list members enumerate their management strategies for RV failure.
>> This is for two reasons. _ one for th3e Wiki and presently
>> I have  a patient who was in low output  and taken for a semi emergency 
>> MVR with maze with TV plasty. Patient had RV dysfunction and congestive 
>> hepatopathy. Had a difficult wean - LV good but RV function was pretty 
>> poor. Patient is in coagulopathy which seems to have decreased .No 
>> mechanical problem on epicardial echo.
>> Patient has an open chest and has adequate CI (PA cath with CCO) has a 
>> high PVR and low SVR and is requiring multiple inotropes (Dopa = Dobut 
>> +Adrenaline + Norad +Milrinone and Vasopressin on one hand and multiple 
>> vasodilators on the other (getting constrictors via the central lumen of 
>> the IABP and dilators via the PA catheter) . I put the IABP as the 
>> patient has OK CI but low pressures due to a vasoplegic state and was 
>> worried that the coronary flow may not be adequate creating a vicious 
>> spiral 9and is helping in maintaining pressures).
>> Funny thing is patient has bilateral dilated and fixed pupils but has 
>> actually woken up once !! (On an infusion of morphine + Ketamine)
>> Prasanna
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