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Article

Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution

1
Departamento de Paciente Crítico, Clínica Alemana de Santiago, Santiago 7650567, Chile
2
Escuela de Medicina. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
3
Escuela de Kinesiología. Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago 7710162, Chile
4
Programa Hantavirus, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago 7590943, Chile
5
Departamento de Pediatría, Clínica Alemana de Santiago, Santiago 7650567, Chile
*
Author to whom correspondence should be addressed.
Viruses 2019, 11(10), 900; https://doi.org/10.3390/v11100900
Received: 1 August 2019 / Revised: 21 September 2019 / Accepted: 23 September 2019 / Published: 27 September 2019
(This article belongs to the Special Issue Hantaviruses)
Hantavirus cardiopulmonary syndrome (HCPS) is characterized by capillary leak, pulmonary edema (PE), and shock, which leads to death in up to 40% of patients. Treatment is supportive, including mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO). Hemodynamic monitoring is critical to titrate therapy and to decide ECMO support. Transpulmonary thermodilution (TPTD) provides hemodynamic and PE data that have not been systematically used to understand HCPS pathophysiology. We identified 11 HCPS patients monitored with TPTD: eight on MV, three required ECMO. We analyzed 133 measurements to describe the hemodynamic pattern and its association with PE. The main findings were reduced stroke volume, global ejection fraction (GEF), and preload parameters associated with increased extravascular lung water and pulmonary vascular permeability compatible with hypovolemia, myocardial dysfunction, and increased permeability PE. Lung water correlated positively with heart rate (HR, r = 0.20) and negatively with mean arterial pressure (r = −0.27) and GEF (r = −0.36), suggesting that PE is linked to hemodynamic impairment. Pulmonary vascular permeability correlated positively with HR (r = 0.31) and negatively with cardiac index (r = −0.49), end-diastolic volume (r = −0.48), and GEF (r = −0.40), suggesting that capillary leak contributes to hypovolemia and systolic dysfunction. In conclusion, TPTD data suggest that in HCPS patients, increased permeability leads to PE, hypovolemia, and circulatory impairment. View Full-Text
Keywords: Hantavirus cardiopulmonary syndrome; Hantavirus pulmonary syndrome; transpulmonary thermodilution; pulmonary edema; Andes virus Hantavirus cardiopulmonary syndrome; Hantavirus pulmonary syndrome; transpulmonary thermodilution; pulmonary edema; Andes virus
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MDPI and ACS Style

López, R.; Pérez-Araos, R.; Salazar, Á.; Ulloa, A.L.; Vial, C.; Vial, P.A.; Graf, J. Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution. Viruses 2019, 11, 900. https://doi.org/10.3390/v11100900

AMA Style

López R, Pérez-Araos R, Salazar Á, Ulloa AL, Vial C, Vial PA, Graf J. Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution. Viruses. 2019; 11(10):900. https://doi.org/10.3390/v11100900

Chicago/Turabian Style

López, René, Rodrigo Pérez-Araos, Álvaro Salazar, Ana L. Ulloa, Cecilia Vial, Pablo A. Vial, and Jerónimo Graf. 2019. "Hemodynamic and Pulmonary Permeability Characterization of Hantavirus Cardiopulmonary Syndrome by Transpulmonary Thermodilution" Viruses 11, no. 10: 900. https://doi.org/10.3390/v11100900

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