Inhaled pulmonary vasodilators are generally quite safe. They offer a variety of physiologic benefits to patients with cardiopulmonary failure, including improved oxygenation and right ventricular function. Unfortunately, like so many interventions in critical care, there is a dearth of large, multi-center RCTs proving patient-centered benefit. This chapter attempts to sift through available evidence, in efforts to use these agents in a rational fashion.
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The IBCC chapter is located here.
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Josh ,I think you are more than super intelligent intensivist and physician ,even the way you are discussing each topic is totally different from any other resources it is logical ,targeted to the point ,very informative and answering all the practical question and now IAM totally addicted to Emcrit . one day in crashing difficult to ventilate trachestomised patient finally the patient was found to have big clot occluding the airway ,until that was figured out and clot was removed meanwhile the patient was hypoxic just we used nitric oxide with ambu bag the oxygen saturation improved and give us… Read more »
advice against adding fluids in this situation, favoring inhaled nitroglycerin etc
https://emcrit.org/emcrit/right-heart-sara-crager/
https://emcrit.org/pulmcrit/ntg/
https://emcrit.org/emcrit/inhaled-pulmonary-vasodilators/
Theory: Layman has ‘purse’ with spray nitroglycerin to load into pocket mesh nebulizer. Reads that https://litfl.com/right-ventricular-infarction-ecg-library/ “Right ventricular infarction complicates up to 40% of inferior STEMIs”. Desert Island treatment of person who looks like they are dying/ lacking oxygenation in some way ? Somehow figure out that there is : 1. no LVOTO or RVOTO outflow valve blockage, weird valve sounds on stethescope? 2. cardiogenic pulmonary edema will not get worse, or doomed anyway? 3. do not have a subarachnoid hemorrhage(headache, stiff wierd) 1. nebulize nitroglycerin (or Milrinone, Amyl nitrite), give O2 if available, tilt up or prone. 2. does… Read more »
in my country, there is debate whether inhaled tools are safe or not , compared than oral medicine. thanks for article