ブックタイトル第43回日本集中治療医学会学術集会プログラム・抄録集

概要

第43回日本集中治療医学会学術集会プログラム・抄録集

－173－IL7-1 Pathophysiology and management of cardiac pulmonary edemaDepartment of Intensive Care Medicine, University of Barcelona, SpainJosep MasipThe term cardiogenic acute pulmonary edema（APE）essentially defines the acute respiratory failure seen in left ventricularfailure（LVF）. Hydrostatic pulmonary edema with an imbalance in the starling forces in the capillaries is the mainpathophysiological mechanism. However, new insights have shown that nitric oxide（NO）-dependent alveolar fluid reabsorption,chloride and sodium transport alveolar fluid secretion and alveolar-capillary stress failure with inflammatory response may alsoplay a role in the genesis of this complication. The pathophysiology of APE seen in other settings, out of（what do you mean byout of here?）LVF, for example in high-altitude（what, cases?）, neurogenic ___? or in marathon runners, discloses/indicates?that individual genetic susceptibility is crucial, leading to defective NO synthesis with selectively excessive hypoxic pulmonaryvasoconstriction, extreme catecholamine reaction or the overcoming（can you find a better word for overcoming here, it’s notclear）of lymphatic drainage capacity as the main contributing factors in other scenarios.Repetitive and severe decompensation may alter cardiopulmonary remodeling, producing chronic alterations in the lungparenchyma and bronchi with/in? a restrictive pattern, cardiac asthma and pulmonary hypertension.The therapeutic approach in APE is mainly based on hemodynamic and respiratory support. The decrease of pulmonarycapillary pressure, preload and afterload with vasodilators（primarily nitroglycerine and exceptionally nitroprusside）anddiuretics, together with the relief of the respiratory distress with oxygen and noninvasive ventilation are the main goals of thetreatment. The role of some sedative agents（mainly opiates）may be controversial and should be individualized. Inotropicsupport is restricted to patients who are refractory to standard therapy or those with hypotension and signs of hypoperfusion.New experimental vasodilators, currently under phase III studies（ularitide or serleaxin）, others already commercially available（nicorandil, LCZ695 or clevidipine）and some others in a more preliminary phase of investigation（like Bay 1021189, canderitide,TRV 120027, CXL-1020）may be considered in the future.招聘講演 7 2月13日（土）　15：40～16：30　第5会場IL7-2 Recent Concept for the Pharmacological Management of Acute Heart FailureDepartment of Anesthesia and Critical care, University of Paris Diderot, FranceAlexandre Mebazaa